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Virginia rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $24.39 / $24.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $22.95 / $30.76
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.09 / $13.09 / $13.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.94 / $26.94 / $26.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.45 / $28.69 / $37.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $15.00 / $40.58
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.26 / $29.41 / $43.04
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.26 / $29.41 / $43.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $30.12