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Nebraska rates for HCPCS 25275

Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,241.22 / $9,544.15 / $20,928.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,094.34 / $5,385.17 / $10,416.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,368.73 / $2,368.73 / $2,368.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.65 / $1,082.64 / $5,405.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,234.00 / $1,553.00 / $2,961.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,341.00 / $7,441.00 / $8,816.00