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Vermont rates for HCPCS Q4126

Memoderm Dermaspan Tranzgraft Or Integuply Per Square Centimeter (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $71.66 / $119.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $119.44
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $71.66 / $119.44
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $119.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $187.23