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West Virginia 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
$1,618.75 / $3,639.68 / $3,805.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.53 / $31.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $45.35
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $70.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.21 / $47.21 / $73.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $54.10