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MemoDerm, DermaSpan, TranZgraft or InteguPly

Utah 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?

$72.44

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $72.44 for this service. The price depends on where it is billed: about $69.18 from a physician practice, and about $72.44 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 7 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$69.18$63.10 to $126
FacilityA hospital or hospital-owned outpatient department$72.44$72.44 to $83.18

How much rates vary

Facilitymedian $72 · 10th to 90th $72 to $120Professionalmedian $69 · 10th to 90th $63 to $158
$100$200$500facility $72professional $69

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
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$67.61
Typical High
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$91.20
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$109.65
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$141.25
Typical High
$162.18
Select Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$120.23
Typical High
$144.54
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$169.82
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Utah 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.

Utah· 15th of 51

$72.44

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.