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Virginia rates for HCPCS A2013

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,377.00 / $1,377.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,296.00 / $1,729.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,360.69 / $1,648.31 / $2,142.81
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,620.00 / $2,097.17
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,337.00 / $1,994.00 / $2,719.18
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.98 / $1,241.44 / $2,024.41
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.98 / $1,241.44 / $2,024.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,440.45