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West Virginia rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, 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 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $616.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $4,265.80 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,691.53 / $2,691.53