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Pennsylvania rates for HCPCS Q4156

Neox 100 Or Clarix 100 Per Square Centimeter (Desc Revised 1/1/2018)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $66.54 / $175.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $66.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.24 / $65.88 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $69.92
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.26 / $65.88 / $89.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $67.01 / $175.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $67.01
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.15 / $65.88 / $65.88
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $83.77
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
$65.88 / $65.88 / $110.14