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Pennsylvania rates for HCPCS 25115

Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $4,265.80 / $8,511.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,248.07 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,890.45 / $5,011.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $4,073.80 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,548.82
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,162.28 / $5,754.40