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Pennsylvania rates for HCPCS 27122

Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.76 / $4,048.00 / $8,451.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,250.74 / $1,250.74 / $1,250.74
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$124.19 / $124.19 / $124.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.76 / $4,993.00 / $10,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,250.74 / $1,250.74 / $1,250.74
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$124.19 / $124.19 / $124.19
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.52 / $1,078.52 / $1,374.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00