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Virginia 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
$1,175.22 / $5,328.00 / $9,347.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.12 / $771.12 / $776.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.59 / $835.32 / $986.52
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.37 / $869.16 / $1,259.95
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.58 / $851.16 / $2,925.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,121.00 / $9,270.00 / $17,192.00