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Virginia rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $194.98 / $251.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $223.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $151.36 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $213.80 / $354.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $309.03 / $1,096.48
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $309.03 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $134.90