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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
$26.44 / $57,915.28 / $97,305.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $26.44 / $26.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $41.69
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.32 / $34.32 / $34.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.00 / $32.00 / $106.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.44 / $31.11 / $43.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $43.00 / $79.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $33.19