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West Virginia rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.43 / $107.77 / $107.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $107.76 / $112.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $106.70 / $160.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $247.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.66 / $479.40 / $479.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.15 / $147.15 / $147.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $563.96