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Pennsylvania rates for HCPCS Q4122

Dermacell Dermacell Awm Or Dermacell Awm Porous Per Square Centimeter (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $102.85 / $102.85
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.74 / $100.43 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.43 / $100.43 / $100.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $108.90 / $108.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $173.82
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $102.85 / $122.39
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.92 / $29.92 / $29.92
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.92 / $29.92 / $30.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $151.91