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Pennsylvania rates for HCPCS 22904

Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; less than 5 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.85 / $1,069.33 / $2,726.23
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.58 / $1,682.05 / $2,190.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.72 / $1,377.33 / $2,310.71
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.18 / $1,676.48 / $1,676.48
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.85 / $1,110.22 / $3,261.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $1,150.40 / $2,661.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.72 / $1,402.37 / $2,310.71
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,026.89 / $1,026.89 / $1,041.29
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.20 / $1,039.22 / $1,082.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.00 / $2,391.00 / $4,789.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.20 / $1,341.74 / $2,119.26