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Pennsylvania rates for HCPCS 25116

Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.34 / $3,873.54 / $8,247.00
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
$695.98 / $695.98 / $695.98
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,826.20 / $7,062.48 / $8,615.36
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.34 / $4,264.00 / $8,404.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.98 / $695.98 / $695.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.86 / $593.86 / $849.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00