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Montana 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
Professional
Modifier
Low / Median / High Price
$912.01 / $1,288.25 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,412.54 / $1,548.82
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,584.89 / $1,905.46
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,584.89 / $1,905.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,380.38 / $2,089.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,258.93 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $1,737.80