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Maryland rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $24.39 / $24.39
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.09 / $13.09 / $13.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.94 / $26.94 / $29.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $30.12
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $16.91 / $16.91