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Pennsylvania rates for HCPCS 01402

Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$851.14 / $851.14 / $1,000.00
Aetna
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$1,862.09 / $1,862.09 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Facility
Modifier
QY
Low / Median / High Price
$30.90 / $30.90 / $30.90
Martin's Point
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$851.14 / $851.14 / $1,000.00
Martin's Point
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$1,862.09 / $1,862.09 / $4,677.35