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Mississippi 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
$65.53 / $65.53 / $74.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $65.53 / $74.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.22 / $54.22 / $54.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.75 / $87.75 / $87.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.29 / $62.41 / $81.13