go back

Pennsylvania rates for HCPCS 22103

Prtl Exc Pst Vrt Intrnsc B1y Les 1 Vrt Sgm Ea

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $3,066.00 / $7,799.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.81 / $152.81 / $152.81
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$14.95 / $14.95 / $14.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,839.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.81 / $152.81 / $152.81
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$14.95 / $14.95 / $14.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.87 / $131.87 / $141.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00