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West 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
$511.30 / $661.85 / $661.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $661.85 / $688.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $982.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,519.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $1,537.00 / $1,537.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.64 / $655.29 / $1,749.83