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Colorado rates for HCPCS Q4126

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $62.41 / $62.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $64.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $117.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $66.16 / $112.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.03 / $68.66 / $88.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.90 / $189.90 / $189.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41