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Pennsylvania rates for HCPCS 11971

Removal of tissue expander without insertion of implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.14 / $2,326.00 / $8,017.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,495.91 / $5,333.15 / $5,420.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,222.00 / $5,833.72 / $7,659.82
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,381.42 / $5,381.42 / $15,001.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,422.00 / $8,017.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,495.91 / $5,333.15 / $5,420.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.16 / $627.16 / $627.16
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.98 / $356.77 / $537.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,884.00 / $6,000.00