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Vermont rates for HCPCS Q4221

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

Insurance Carrier
Aetna
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
$1,850.00 / $2,280.00 / $3,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $3,800.00
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.00 / $2,280.00 / $3,800.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $3,800.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $5,883.00