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Georgia rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $81.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $89.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $204.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $162.18 / $229.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $89.13 / $125.89