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Delaware 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
$220.91 / $220.91 / $220.91
Aetna
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,005.38 / $16,005.38 / $16,005.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.00 / $136.47 / $204.71