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Michigan rates for HCPCS 25316

Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist; with tendon(s) transfer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $933.25 / $1,621.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,122.02 / $2,630.27
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $4,073.80 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,000.00 / $1,412.54
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,071.52 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $9,120.11 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,096.48 / $1,479.11