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Maryland rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.20 / $38.20 / $38.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $38.20 / $44.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.78 / $40.78 / $40.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.34 / $43.34 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $57.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.23 / $44.98 / $50.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $53.74
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94