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Virginia rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $116.71 / $116.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $116.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.16 / $335.16 / $447.37
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.16 / $335.16 / $373.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.86 / $104.86 / $111.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.48 / $111.15 / $285.98
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $116.71 / $317.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.00 / $555.14 / $762.82
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.02 / $379.00 / $673.26
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.02 / $379.00 / $673.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $122.23