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West Virginia rates for HCPCS Q4173

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.59 / $352.51 / $352.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $352.51 / $366.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $349.02 / $523.53
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $809.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.26 / $688.50 / $688.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.01 / $349.01 / $349.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $1,139.54