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Virginia rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,318.26
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $407.38 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $173.78 / $977.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $125.89 / $977.24
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $112.20 / $933.25
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $588.84 / $1,380.38
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $588.84 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $177.83 / $812.83