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Idaho rates for HCPCS 26502

Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,422.00 / $4,500.00 / $8,622.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.07 / $1,006.22 / $1,562.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,895.78 / $1,895.78 / $1,901.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $1,113.29 / $1,322.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.00 / $1,327.30 / $1,796.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,221.68 / $1,332.74 / $1,778.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,176.63 / $1,311.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,490.98 / $7,849.65 / $9,927.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.94 / $1,532.95 / $1,778.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,500.00 / $9,360.00 / $17,870.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.80 / $1,084.72 / $1,543.64