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Virginia 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 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $85.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $144.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $131.83
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 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $151.36 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $81.28 / $154.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $109.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $83.18 / $125.89