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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)

Facilitymedian $120 · 10th–90th $102$52,4810%50%10th90th$120Professionalmedian $102 · 10th–90th $95$1260%50%10th90th$102$0.1$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $20,892.96 / $54,954.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $102.33 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $169.82
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $131.83 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $120.23 / $173.78
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $120.23 / $120.23
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $120.23 / $162.18
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $120.23 / $162.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $199.53 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89