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Pennsylvania rates for HCPCS 15004

Prep Site F/S/N/H/F/G/M/D Gt 1st 100 Sq Cm/1pct

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.87 / $1,770.67 / $6,432.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.83 / $345.21 / $646.75
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.89 / $399.41 / $716.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,064.00 / $2,064.00 / $2,064.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.26 / $372.24 / $606.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.10 / $591.55 / $610.07
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.03 / $831.23 / $2,934.60
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.90 / $2,202.00 / $7,197.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.53 / $365.87 / $1,043.33
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.50 / $300.50 / $314.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.54 / $442.54 / $2,064.00
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$44.25 / $44.25 / $44.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.96 / $381.26 / $648.17
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.58 / $273.79 / $382.89
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.58 / $374.22 / $408.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $650.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.11 / $437.56 / $744.92