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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
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,096.48
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $109.65 / $851.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $363.08 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $302.00 / $1,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $302.00 / $302.00