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Pennsylvania rates for HCPCS 19371

Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $5,495.41 / $11,220.18
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,888.44 / $6,760.83 / $9,120.11
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $6,606.93 / $57,543.99
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $16,982.44 / $17,378.01
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,079.46 / $10,964.78 / $38,904.51
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,786.30 / $10,000.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,888.44 / $6,760.83 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,445.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $691.83 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,981.07 / $12,022.64