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Pennsylvania rates for HCPCS G0289

Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $3,839.00 / $8,451.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.68 / $96.68 / $96.68
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$9.47 / $9.47 / $9.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $5,350.00 / $10,527.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.68 / $96.68 / $96.68
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$9.47 / $9.47 / $9.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.80 / $83.09 / $83.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00