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West 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
$77.62 / $77.62 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $123.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $812.83 / $1,096.48