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Washington, DC rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.25 / $16.25 / $16.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $67.50 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $91.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.82 / $60.82 / $71.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $115.97