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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
$1,283.00 / $2,959.04 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,292.00 / $5,951.00 / $9,100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.22 / $868.22 / $868.22
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,404.46 / $3,603.63 / $4,808.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.42 / $4,029.20 / $8,404.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.22 / $868.22 / $868.22
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.33 / $743.33 / $952.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00