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Pennsylvania rates for HCPCS 19301

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.77 / $6,019.64 / $11,077.50
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,742.50 / $7,697.00 / $8,986.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.09 / $645.36 / $1,792.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.76 / $998.02 / $1,216.33
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,343.84 / $4,579.60 / $51,424.09
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.22 / $955.08 / $1,261.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.17 / $799.99 / $1,402.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.46 / $1,069.92 / $1,069.92
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,490.14 / $8,574.81 / $14,857.50
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,885.40 / $15,741.73 / $55,771.07
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.28 / $788.45 / $1,077.75
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,076.32 / $4,478.08 / $16,052.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,224.00 / $5,366.19 / $11,077.50
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,494.00 / $5,622.00 / $8,986.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.48 / $832.21 / $1,817.40
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.90 / $923.16 / $1,364.24
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.43 / $818.55 / $1,402.74
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$646.42 / $646.42 / $647.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.48 / $647.87 / $682.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.88 / $739.71 / $1,321.97