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West 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
$2,031.16 / $3,009.35 / $3,009.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,009.35 / $3,128.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $4,469.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $6,908.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,863.13 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,855.38 / $2,979.56 / $3,128.54