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Pennsylvania rates for HCPCS 23020

Capsular Contracture Release

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.19 / $2,463.00 / $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
$789.35 / $789.35 / $789.35
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.29 / $78.29 / $78.29
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.19 / $2,463.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.35 / $789.35 / $789.35
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.29 / $78.29 / $78.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.14 / $678.14 / $729.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,368.00