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Washington, DC rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.52 / $35.52 / $35.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $28.52 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $38.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $48.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $49.00