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Georgia 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 / $68.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $63.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $122.32
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
$59.54 / $59.54 / $218.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.10 / $115.47 / $239.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $92.70