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Pennsylvania rates for HCPCS 19370

Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.36 / $3,840.50 / $8,451.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,597.00 / $9,604.09 / $11,278.37
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,610.98 / $7,969.99 / $16,478.62
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,569.97 / $14,634.82 / $23,970.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.45 / $4,534.00 / $8,404.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,597.00 / $7,655.00 / $15,119.79
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.42 / $655.42 / $752.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,000.00