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Pennsylvania rates for HCPCS 25455

Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $4,786.30 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $1,584.89
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $776.25 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,445.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,122.02 / $1,412.54
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $933.25 / $1,479.11
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,890.45 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $2,137.96
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,513.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $1,445.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $912.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $478.63 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,365.16 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,380.38