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Virginia rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $14,410.46 / $52,195.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $31.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $40.09
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.21 / $31.21 / $42.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.22 / $28.22 / $29.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.42 / $29.91 / $38.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $31.21 / $48.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $53.69 / $73.75
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.70 / $35.31 / $46.05
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.70 / $35.31 / $46.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $31.91