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Virginia rates for HCPCS Q4126

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

Facilitymedian $66 · 10th–90th $62–$1480%20%10th90th$66Professionalmedian $65 · 10th–90th $62–$1260%20%10th90th$65$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $97.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $138.04
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $131.83 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $69.18 / $120.23
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $72.44 / $93.33
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $72.44 / $93.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $104.71 / $134.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $125.89