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Pennsylvania rates for HCPCS 43121

Prtl Esophagec W/Wo Prox Gastrec/Pyloroplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $3,839.00 / $8,113.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.44 / $2,851.90 / $3,663.17
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,816.82 / $2,923.12 / $2,923.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $3,227.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,231.66 / $3,375.04 / $5,992.60
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,285.38 / $6,285.38 / $6,285.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,383.09 / $4,307.37 / $5,628.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,480.64 / $2,927.63 / $5,958.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,258.10 / $2,258.10 / $2,258.10
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $3,040.70 / $7,009.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $3,227.34
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,160.67 / $3,341.49 / $5,992.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,761.57 / $2,761.57 / $2,880.51
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,639.78 / $2,813.06 / $2,893.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $2,020.00 / $6,228.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,241.44 / $3,208.31 / $5,481.42