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Pennsylvania rates for HCPCS 11004

Dbrdmt Skn Sbq T/M/F Necro Infctj Xtrnl Gent&Per

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516.30 / $3,839.00 / $8,247.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $4,761.00 / $8,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.98 / $645.98 / $645.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.82 / $553.82 / $602.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $2,391.00 / $6,322.00