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Pennsylvania rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.19 / $18.80 / $812.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.11
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.72 / $7.87 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.17 / $8.53 / $10.67
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.19 / $7.87 / $18.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $12.15
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.20 / $12.90 / $15.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.87 / $7.87
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.06 / $7.06 / $8.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $7.06 / $8.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.12