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Vermont rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $80.94 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $134.90
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $80.94 / $134.90
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $134.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $227.37