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Virginia rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $1,020.00 / $1,020.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,289.08
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $100.84 / $100.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.19 / $710.09 / $710.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,200.00 / $1,553.46
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.00 / $1,200.00 / $1,200.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,750.00 / $10,945.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,750.00 / $10,945.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $828.44