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Virginia rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $102.84 / $102.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $102.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $134.18 / $288.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $131.27
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.06 / $105.06 / $105.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.40 / $92.40 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.25 / $97.94 / $190.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $98.63 / $165.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.23 / $121.09 / $217.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.67 / $107.55 / $205.23
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.67 / $107.55 / $205.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $122.91