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Pennsylvania rates for HCPCS 15115

Epidermal Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/<

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$737.79 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.54 / $701.06 / $999.13
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
$806.83 / $837.28 / $1,423.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.61 / $833.06 / $1,450.05
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.34 / $1,234.72 / $1,274.82
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.36 / $750.41 / $3,588.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.60 / $962.60 / $1,096.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.29 / $1,191.29 / $1,191.29
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.16 / $843.77 / $1,571.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.29 / $673.47 / $782.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.29 / $739.46 / $828.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.00 / $1,734.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.65 / $879.19 / $1,524.29