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Maryland rates for HCPCS Q4126

Memoderm Dermaspan Tranzgraft Or Integuply Per Square Centimeter (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $59.81 / $2,201.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $68.66
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.88 / $82.88 / $82.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $82.88
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 / $62.41 / $83.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $65.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.81 / $62.41 / $81.76