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Florida rates for HCPCS Q4126

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

Facilitymedian $63 · 10th–90th $62–$1860%20%40%10th90th$63Professionalmedian $63 · 10th–90th $62–$1260%20%10th90th$63$1.0$5.0$20.0$100.0$500.0

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 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $63.10 / $74.13
AvMed
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $107.15 / $125.89
AvMed
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Florida Blue
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
Florida Blue
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $93.33 / $141.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $60.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $102.33 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $128.82