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Connecticut rates for HCPCS Q4205

Membrane Graft Or Membrane Wrap Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,286.78 / $1,286.78 / $1,936.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,249.66 / $1,299.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,835.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.30 / $1,237.28 / $1,312.51