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Pennsylvania rates for HCPCS Q4153

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.69 / $137.93 / $286.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $139.31
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.75 / $137.93 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.12 / $137.93 / $137.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.24 / $143.13 / $238.55
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.69 / $137.93 / $286.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.53 / $137.93 / $139.31
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.12 / $137.93 / $137.93
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $138.33
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.65 / $160.65 / $186.42
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.65 / $160.65 / $186.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $206.90