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MemoDerm, DermaSpan, TranZgraft or InteguPly

Pennsylvania 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?

$63.10

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $63.10 for this service. The price depends on where it is billed: about $63.10 from a physician practice, and about $67.61 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$63.10$63.10 to $70.79
FacilityA hospital or hospital-owned outpatient department$67.61$63.10 to $107

How much rates vary

Facilitymedian $68 · 10th to 90th $63 to $447Professionalmedian $63 · 10th to 90th $63 to $126
$100$500$2K$10K$50Kfacility $68professional $63

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
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$69.18
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$81.28
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$263.03
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$218.78
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$107.15
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$66.07
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$102.33
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$125.89
Typical High
$138.04

Where Pennsylvania 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.

Pennsylvania· 32nd of 51

$63.10

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.