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Pennsylvania rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $85.00 / $85.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.86 / $83.00 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.00 / $83.00 / $83.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.25 / $85.00 / $85.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $85.00 / $85.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $222.23