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Montana rates for HCPCS 25375

Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius AND ulna

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.83 / $1,338.03 / $4,989.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,519.04 / $1,519.04 / $1,519.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.22 / $1,519.04 / $1,598.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.48 / $1,034.66 / $1,519.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.42 / $1,519.04 / $1,987.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,233.70 / $1,543.92 / $2,371.02