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Vermont rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.83 / $339.83 / $993.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.38 / $1,052.89 / $1,052.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.83 / $339.83 / $993.29
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.38 / $1,052.89 / $1,092.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $3,158.67