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Virginia rates for HCPCS Q4233

SurFactor or NuDyn, per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $5,120.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.50 / $487.50 / $662.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,625.00 / $4,639.00 / $4,639.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$894.00 / $2,484.00 / $10,945.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.00 / $2,484.00 / $10,945.00