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Pennsylvania rates for HCPCS 19380

Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $6,165.95 / $10,715.19
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,011.87 / $7,585.78 / $14,454.40
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $15,135.61 / $25,118.86
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,011.87 / $14,454.40 / $23,988.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $5,623.41 / $10,715.19
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,466.84 / $7,585.78 / $16,982.44
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,659.59
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $20,417.38