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Connecticut rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,288 · 10th–90th $145–$2,0420%20%10th90th$1,288Professionalmedian $1,230 · 10th–90th $398–$1,3490%20%40%10th90th$1,230$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $2,041.74 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,348.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $1,230.27 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $144.54 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $1,318.26 / $1,412.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $691.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $1,862.09