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Connecticut 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
$1,096.48 / $1,737.80 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $1,047.13 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $851.14 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $134.90 / $1,000.00