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Montana 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 / $1,905.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $954.99 / $1,202.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,318.26 / $1,479.11
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,318.26 / $1,479.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $977.24 / $1,548.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $954.99 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,148.15 / $1,380.38