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Maryland rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.48 / $14.48 / $14.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $14.15
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.18 / $7.18 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $16.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.93 / $12.86 / $19.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $13.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.15 / $15.15 / $16.85