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Pennsylvania rates for HCPCS 58200

Tot Abd Hyst W/Paraortic & Pelvic Lymph Node Sam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,199.29 / $5,254.00 / $10,398.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,526.00 / $11,083.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,320.29 / $1,320.29 / $1,448.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $2,391.00 / $6,322.00