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Virginia rates for HCPCS Q4137

AmnioExcel, AmnioExcel Plus or BioDExcel, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $269.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $371.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $162.18 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $173.78 / $263.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $112.20 / $269.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $234.42
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $112.20 / $186.21
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $112.20 / $186.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $134.90 / $223.87