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Pennsylvania rates for HCPCS 25275

Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.08 / $3,612.00 / $8,451.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.12 / $771.12 / $771.12
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,044.23 / $10,044.23 / $23,196.39
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.08 / $4,142.81 / $8,451.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.12 / $771.12 / $771.12
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.29 / $661.27 / $661.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,368.00