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Pennsylvania rates for HCPCS G0454

Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist

Facilitymedian $8 · 10th–90th $8–$130%50%90th$8Professionalmedian $8 · 10th–90th $6–$150%50%10th90th$8$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.94 / $7.94 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $7.94 / $10.00
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $10.23 / $13.18
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.71 / $9.12 / $16.60
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $13.49 / $13.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $8.32 / $8.32
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $16.98 / $16.98
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $12.88 / $18.20
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.71 / $10.47 / $16.60
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.94 / $7.94 / $7.94
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $7.94 / $10.00
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $16.22 / $19.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.90 / $8.71 / $9.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.90 / $8.71 / $16.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.41 / $9.77 / $17.38