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Pennsylvania rates for HCPCS 69604

Revj Mastoidectomy Rsltg Tympanoplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,203.07 / $5,254.00 / $10,637.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.84 / $1,116.05 / $2,914.02
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.11 / $1,535.90 / $2,070.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,034.30 / $1,408.06 / $2,266.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.71 / $1,730.85 / $1,745.58
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,834.96 / $10,834.96 / $12,495.40
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,526.00 / $11,083.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.84 / $1,203.07 / $5,828.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $1,290.30 / $2,909.20
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.64 / $1,424.82 / $2,358.85
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,093.03 / $1,093.03 / $1,359.36
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.33 / $1,093.03 / $1,359.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,914.00 / $7,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.22 / $1,324.19 / $2,174.69