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Pennsylvania rates for HCPCS Q4170

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.31 / $39.71 / $109.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.71
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.56 / $39.31 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $44.51
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.94 / $40.79 / $50.22
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.31 / $41.97 / $109.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $41.97
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.09 / $39.31 / $39.31
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $50.07
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.11 / $81.11 / $94.12
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.11 / $81.11 / $94.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $67.75