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Maryland rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.04 / $27,179.60 / $76,488.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.51 / $26.44 / $26.44
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.32 / $34.32 / $34.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.98 / $27.98 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $39.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.00 / $30.00 / $32.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $32.82
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.20 / $32.20 / $32.20