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West Virginia rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.20 / $38.20 / $38.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $38.20 / $38.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.98 / $24.76 / $24.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.98 / $23.98 / $23.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $50.94