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Pennsylvania rates for HCPCS 25265

Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $3,066.00 / $7,799.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.96 / $754.58 / $1,113.16
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.26 / $789.99 / $1,207.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$861.51 / $861.51 / $861.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.89 / $947.18 / $1,549.17
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$901.86 / $1,221.96 / $1,557.75
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.08 / $754.08 / $843.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,839.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.43 / $848.41 / $3,735.38
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.67 / $1,116.70 / $1,542.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$861.51 / $861.51 / $861.51
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.95 / $969.53 / $1,599.34
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$737.02 / $737.02 / $991.32
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.61 / $739.38 / $991.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,368.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.30 / $1,001.21 / $1,489.75