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Virginia rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $8.27 / $8.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $10.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $7.29 / $9.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.43 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.69 / $7.87 / $9.92
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $8.27 / $12.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $11.65 / $18.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $8.19 / $10.68
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $8.19 / $10.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.26