go back

Montana rates for HCPCS 25455

Epiphysl Arrst Epiphysiod/Stapling Dstl Rds&Ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,820.50 / $3,820.50 / $3,820.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.51 / $1,029.85 / $3,818.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.96 / $1,170.96 / $1,170.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.33 / $990.91 / $1,170.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.07 / $797.60 / $1,140.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.23 / $1,107.47 / $1,526.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.47 / $918.47 / $6,489.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.81 / $1,161.60 / $1,330.97