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Colorado rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $1,052.89 / $1,052.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,084.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.39 / $222.39 / $222.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.39 / $222.39 / $469.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.77 / $993.29 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $1,116.06 / $1,707.57
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.65 / $1,158.18 / $1,421.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89