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West Virginia rates for HCPCS Q4257

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.86 / $924.24 / $924.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $924.24 / $960.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.09 / $915.09 / $1,372.64
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $2,121.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$863.29 / $1,417.80 / $1,417.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $915.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $1,667.22