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Virginia rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $74.23 / $74.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $74.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $94.76
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.12 / $255.00 / $255.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $66.69 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.10 / $70.70 / $273.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $74.23 / $135.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.00 / $295.14 / $314.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.47 / $204.71 / $378.35
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.47 / $204.71 / $378.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.34 / $121.34 / $273.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $70.70 / $77.75