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Pennsylvania rates for HCPCS 15840

Graft Facial Nerve Paralysis Free Fascial Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$926.36 / $4,304.00 / $8,247.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,404.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,141.25 / $1,141.25 / $1,141.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$989.29 / $989.29 / $1,104.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.00 / $3,475.00 / $6,368.00