go back

Pennsylvania rates for HCPCS Q4154

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.90 / $133.22 / $377.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $135.86
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.60 / $131.90 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $143.10
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.65 / $136.87 / $228.12
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.90 / $144.29 / $377.15
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $171.71
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.43 / $131.90 / $131.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $149.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.16 / $158.16 / $183.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.16 / $158.16 / $183.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $197.85