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Connecticut rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $691.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $549.54 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $676.08 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $134.90 / $2,691.53