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Virginia rates for HCPCS A2015

Phoenix wound matrix, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.03 / $83.03 / $390.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.53 / $83.03 / $390.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.38 / $59.38 / $82.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,062.39 / $1,062.39 / $1,062.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.24 / $785.24 / $785.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.13 / $1,451.40 / $1,904.72
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.03 / $126.45 / $624.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.00 / $923.69 / $1,227.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.71 / $128.41 / $237.36
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.71 / $128.41 / $237.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.66 / $1,438.66 / $1,510.59