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Pennsylvania rates for HCPCS Q4175

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.39 / $91.54 / $178.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $92.45
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.15 / $91.54 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.68 / $95.00 / $116.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.39 / $91.54 / $178.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.38 / $91.54 / $92.45
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.36 / $91.54 / $91.54
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $99.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.38 / $63.38 / $73.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.38 / $63.38 / $73.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $137.31