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Montana rates for HCPCS 28202

Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $977.24 / $1,071.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $758.58 / $1,096.48