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Vermont rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $7.41 / $8.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $8.91 / $125.89