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MemoDerm, DermaSpan, TranZgraft or InteguPly

Ohio rates for HCPCS Q4126

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

Rates data updated July 2026.

How much does MemoDerm, DermaSpan, TranZgraft or InteguPly cost?

$66.07

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $66.07 for this service. The price depends on where it is billed: about $66.07 from a physician practice, and about $102 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$66.07$63.10 to $97.72
FacilityA hospital or hospital-owned outpatient department$102$63.10 to $240

How much rates vary

Facilitymedian $102 · 10th to 90th $63 to $316Professionalmedian $66 · 10th to 90th $63 to $126
$100$200facility $102professional $66

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$69.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$77.62
Typical High
$154.88
CareSource
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
CareSource
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$85.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$269.15
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$269.15
Typical High
$389.05
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$93.33
Typical High
$128.82
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$141.25
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$125.89

Where Ohio sits

The same service costs 2.0 times more in Alaska than in Arkansas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Ohio· 20th of 51

$66.07

AK $126AR $63.10

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.