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Florida 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 / $1,095.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.29 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.00 / $1,052.89 / $1,052.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $70.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.37 / $871.37 / $1,052.89