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West 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
$4.98 / $7.95 / $7.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.95 / $8.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $18.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.40