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Virginia rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $55.39 / $55.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $55.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $70.70
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.25 / $34.25 / $63.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.77 / $49.77 / $52.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $52.75
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.84 / $52.75 / $68.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $54.86 / $84.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.00 / $73.11 / $108.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.40 / $56.30 / $94.99
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.40 / $56.30 / $94.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $55.39