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Connecticut rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.81 / $78.81 / $135.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $78.81 / $86.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $155.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $75.79 / $79.58