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Pennsylvania rates for HCPCS 40804

Rmvl Embedded Fb Vestibule Mouth Smpl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.85 / $2,747.00 / $8,104.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.08 / $173.71 / $229.25
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.40 / $198.63 / $295.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.03 / $206.96 / $346.34
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.82 / $308.74 / $317.72
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $3,964.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.73 / $180.86 / $630.16
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $160.80 / $515.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.02 / $213.18 / $365.24
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.66 / $145.43 / $223.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.21 / $178.08 / $195.20
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
$172.54 / $251.54 / $396.63