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Montana rates for HCPCS 25680

Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $676.08 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $691.83 / $851.14
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $933.25 / $1,000.00
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $933.25 / $1,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $660.69 / $977.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $707.95 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,000.00