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West 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 / $26.44 / $89,280.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $26.44 / $26.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.38 / $118.38 / $66,081.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $45.06