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Virginia rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $15.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $14.45 / $30.20
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.13 / $22.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $151.36 / $239.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $14.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $13.49 / $26.92
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $7.59 / $12.88
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $16.60 / $21.38
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $16.60 / $21.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $16.22 / $125.89