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Virginia rates for HCPCS 69604

Revision mastoidectomy; resulting in tympanoplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,239.07 / $6,146.00 / $14,798.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.57 / $1,239.07 / $1,372.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,153.00 / $7,363.00 / $9,410.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.08 / $1,318.52 / $1,808.35
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.46 / $1,776.11 / $9,211.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,098.17 / $1,464.35 / $2,717.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.23 / $1,263.88 / $1,558.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,220.73 / $1,486.73 / $2,181.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,381.00 / $1,562.00 / $2,619.98
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,119.48 / $1,470.77 / $6,585.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.48 / $1,470.77 / $6,585.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,693.00 / $11,671.00 / $21,639.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.04 / $1,490.50 / $2,431.15