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Maryland rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.12 / $7.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $7.29 / $7.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.98 / $5.98 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $10.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.30 / $7.87 / $9.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.33 / $7.33 / $10.31