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Florida 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 / $83.94 / $96.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $83.94 / $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
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.98 / $85.95 / $85.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $137.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $80.90 / $80.90