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Pennsylvania rates for HCPCS Q4108

Integra matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.90 / $66.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $54.95
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $53.70 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $41.69
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $162.18
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $131.83 / $199.53
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.90 / $66.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $74.13
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $52.48 / $245.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $44.67 / $54.95
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $44.67 / $190.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $97.72 / $125.89