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Pennsylvania rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $45.25 / $45.25
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,963.10 / $3,486.00 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,486.00 / $3,486.00 / $3,486.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $30.58 / $30.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $45.25 / $45.25
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $66.54