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West Virginia rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,372.70 / $1,980.61 / $1,980.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,980.61 / $2,059.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,941.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $4,546.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.00 / $2,040.00 / $2,040.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.17 / $1,961.00 / $2,400.63