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Virginia rates for HCPCS Q4178

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.41 / $93.88 / $93.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $93.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $119.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.25 / $191.25 / $191.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.35 / $84.35 / $89.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $89.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.00 / $89.41 / $202.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.41 / $93.88 / $163.62
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.00 / $152.00 / $207.65
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.57 / $96.54 / $189.89
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.57 / $96.54 / $189.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $98.32