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Virginia rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $21,877.62 / $95,499.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.12 / $26.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $64.57
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
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
$33.88 / $33.88 / $47.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $30.90 / $64.57
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $25.70 / $30.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $38.90 / $125.89