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Pennsylvania rates for HCPCS 26502

Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$976.00 / $3,830.00 / $8,240.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.12 / $735.01 / $1,272.11
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
$745.74 / $773.88 / $773.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.48 / $857.48 / $857.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.65 / $889.22 / $1,532.30
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.88 / $1,206.51 / $1,543.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $4,597.00 / $8,404.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.12 / $808.19 / $2,337.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$904.50 / $904.50 / $1,610.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.48 / $857.48 / $857.48
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.61 / $906.61 / $1,557.55
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.74 / $742.74 / $812.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.85 / $742.74 / $812.81
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
$671.86 / $887.00 / $1,427.90