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Pennsylvania rates for HCPCS E1353

Regulator (Special Coverage Instructions Apply. See Cim: 60-4 And Mcm: 4107.9)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.79 / $21.83 / $21.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.12 / $20.79 / $28.29
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.57 / $62.83 / $65.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.17 / $25.17 / $68.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.39 / $21.39 / $29.37
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.10 / $83.10 / $83.10
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.40 / $48.28 / $62.22
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.72 / $26.72 / $26.72
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.83 / $21.83 / $21.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.11 / $21.84 / $30.84
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.40 / $59.50 / $78.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.17 / $25.17 / $68.48
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.39 / $21.39 / $45.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.30 / $37.65 / $37.65
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.30 / $37.65 / $37.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $19.73 / $35.70