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Pennsylvania rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $776.25
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $831.76 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $691.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $724.44 / $851.14
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $177.83 / $1,023.29
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $676.08 / $676.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $794.33
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $229.09 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $660.69 / $1,000.00