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Virginia rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $3,128.53 / $3,128.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,128.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,993.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,810.90 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,532.62 / $2,569.84 / $2,979.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,850.00 / $2,979.56 / $4,764.75
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,850.00 / $2,850.00 / $2,850.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,594.62 / $3,380.62 / $5,237.14
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,594.62 / $3,380.62 / $5,237.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,919.97 / $2,979.56 / $3,130.03