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Pennsylvania rates for HCPCS Q4191

Restorigin, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $661.85 / $1,928.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $661.85
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.42 / $655.29 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $680.03
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.01 / $655.29 / $837.06
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $737.74 / $1,928.34
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $737.74
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $655.29 / $655.29
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $834.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $979.94