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West 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 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $15.85
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $54.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $18.62 / $125.89