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Florida rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.43 / $17,706.15 / $46,029.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $100.43 / $102.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.43 / $102.85 / $102.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $110.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $110.00