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Maryland 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
$5,475.95 / $5,475.95 / $5,475.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.52 / $767.32 / $1,809.58
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.62 / $778.50 / $876.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $641.21 / $1,490.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.96 / $966.40 / $1,752.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.66 / $1,026.40 / $1,359.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.00 / $643.00 / $1,185.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.91 / $850.85 / $1,491.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.74 / $915.01 / $1,123.84