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Montana rates for HCPCS 25426

Repair of defect with autograft; radius AND ulna

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.14 / $1,569.75 / $5,866.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,782.99 / $1,782.99 / $1,782.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.49 / $1,782.99 / $1,888.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.06 / $1,212.83 / $1,782.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.86 / $1,782.99 / $2,334.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,526.09 / $1,824.10 / $2,078.08