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Vermont rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $105.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.63 / $31.63 / $61.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $34.36 / $57.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $57.29
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $34.36 / $57.29
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $57.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $90.69