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Virginia rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $55,171.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $102.85 / $102.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $96.80 / $129.19
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.71 / $94.71 / $94.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.82 / $108.93 / $108.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $121.00 / $156.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.95 / $121.00 / $121.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.00 / $114.95 / $165.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $114.95 / $165.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $121.03