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Connecticut 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
$85.96 / $134.47 / $288.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.92 / $85.96 / $85.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $85.96 / $85.96
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.09 / $100.45 / $104.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.55 / $136.47 / $143.29