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Washington, DC 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
$62.41 / $62.41 / $62.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.88 / $82.88 / $82.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $79.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.05 / $53.05 / $83.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $101.15