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Virginia rates for HCPCS Q4159

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.96 / $215.20 / $565.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $215.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $274.72
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.16 / $620.16 / $620.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.35 / $193.35 / $204.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $204.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.22 / $204.96 / $1,139.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.96 / $215.20 / $758.77
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.66 / $805.88 / $1,167.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.56 / $1,203.33 / $1,583.34
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.56 / $1,203.33 / $1,583.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $257.22