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Connecticut rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,039.44 / $2,039.44 / $3,190.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,980.61 / $2,059.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,909.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.95 / $1,961.00 / $2,059.05