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Virginia rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $688.07 / $688.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $688.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $909.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $3,321.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $618.21 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.01 / $655.29 / $1,574.85
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $688.07 / $1,199.20
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.00 / $2,705.00 / $3,688.80
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,436.81 / $1,615.81 / $2,811.61
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.81 / $1,613.76 / $2,811.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $733.94