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Maryland 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
$21,373.60 / $27,006.53 / $28,317.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.22 / $102.85 / $102.85
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.71 / $94.71 / $94.71
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.93 / $108.93 / $121.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $116.60