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West Virginia rates for HCPCS Q4253

Zenith Amniotic Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.23 / $76.55 / $76.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $76.55 / $79.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $113.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $175.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $969.00 / $969.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $1,143.90