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Virginia rates for HCPCS Q4164

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.93 / $1,722.98 / $1,722.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,722.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $2,190.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $3,544.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.05 / $1,548.05 / $1,640.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,640.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,359.07 / $1,394.79 / $1,640.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,560.00 / $1,640.93 / $2,624.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,560.00 / $2,350.00 / $3,204.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,614.43 / $1,640.93 / $1,722.98