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Connecticut rates for HCPCS Q4219

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,621.81 / $1,621.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,000.00 / $1,023.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $112.20 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $758.58 / $851.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $134.90 / $794.33