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Pennsylvania rates for HCPCS 31623

Brnchsc Brushing/Protected Brushings

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.37 / $2,381.00 / $6,216.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.99 / $231.63 / $438.43
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.35 / $47.35 / $47.35
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
$235.13 / $276.62 / $617.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.05 / $260.16 / $482.51
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.75 / $421.53 / $434.83
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.21 / $3,752.89 / $7,352.05
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.26 / $2,421.31 / $6,929.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.63 / $272.38 / $499.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $291.50 / $765.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.47 / $287.07 / $509.78
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.18 / $248.76 / $384.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.18 / $260.10 / $283.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $2,391.00 / $4,789.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.14 / $338.70 / $560.85