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Pennsylvania rates for HCPCS 69604

Revision mastoidectomy; resulting in tympanoplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $7,244.36 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,148.15 / $3,019.95
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,445.44 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,412.54 / $2,187.76
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $1,698.24
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,348.96 / $2,137.96
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $26,915.35 / $33,884.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $5,754.40 / $10,964.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,348.96 / $3,548.13
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $2,344.23
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,737.80 / $2,398.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $912.01 / $1,348.96
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $912.01 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $2,187.76