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Virginia rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.02 / $39.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $74.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $102.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $131.83 / $194.98
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $19.95 / $19.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $41.69 / $83.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $58.88 / $72.44
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $58.88 / $72.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $83.18 / $125.89