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Ohio 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
$974.65 / $4,947.00 / $11,581.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,760.00 / $3,576.00 / $14,996.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.48 / $771.95 / $1,025.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.12 / $771.12 / $771.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,840.00 / $5,625.00 / $7,847.00