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Maine 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
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,995.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,122.02 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,122.02 / $1,698.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $2,089.30
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $933.25 / $1,621.81