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Colorado rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $80.90 / $80.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.78 / $80.90 / $85.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.59 / $92.59 / $92.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.59 / $92.59 / $92.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $92.59 / $135.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $278.00 / $329.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $136.47