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Pennsylvania rates for HCPCS 43204

Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.00 / $2,326.00 / $7,799.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.56 / $139.44 / $211.99
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.69 / $3,159.00 / $14,886.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.58 / $138.62 / $138.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.00 / $1,113.00 / $2,434.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.33 / $223.95 / $370.38
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.62 / $295.62 / $295.62
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.86 / $206.21 / $271.86
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,963.37 / $2,963.37 / $2,963.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,326.00 / $7,799.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.51 / $185.04 / $1,200.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.80 / $278.80 / $278.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $335.90 / $460.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.61 / $795.00 / $2,316.65
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.35 / $219.16 / $378.78
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.56 / $130.56 / $263.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.77 / $131.02 / $263.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.00 / $1,728.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.34 / $182.73 / $288.04