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Connecticut rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,839.83 / $3,839.83 / $6,141.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,729.06 / $3,925.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,812.64 / $3,692.14 / $5,477.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,507.53 / $3,692.14 / $4,098.28