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California rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $105 · 10th–90th $83$2630%20%40%10th90th$105Professionalmedian $68 · 10th–90th $62$2630%20%10th90th$68$0.1$2.0$50.0$1.0K$20.0K$500.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $63.10 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $63.10 / $338.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $104.71 / $263.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $97.72 / $177.83
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.89 / $1.26 / $2.75
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $177.83 / $239.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $165.96 / $269.15
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $87.10
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $85.11 / $213.80
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $125.89 / $125.89
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $89.13 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $316.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $125.89 / $177.83