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Virginia rates for HCPCS Q4151

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $234.42
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $151.36 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $141.25 / $251.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $134.90 / $134.90
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $141.25 / $181.97
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $141.25 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $134.90 / $138.04