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Pennsylvania rates for HCPCS G2004

Post-d/c h vst new pt 60 m

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.69 / $137.69 / $137.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.55 / $143.77 / $181.77
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
$140.34 / $165.11 / $271.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.06 / $141.06 / $141.06
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.12 / $234.12 / $234.12
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.69 / $137.69 / $137.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.68 / $144.74 / $183.71
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.06 / $141.06 / $141.06
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.01 / $158.01 / $200.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.93 / $158.11 / $200.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.56 / $209.32 / $336.74