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Maryland rates for HCPCS Q4151

AmnioBand or Guardian, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.19 / $137.19 / $4,477.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $156.47
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.01 / $126.01 / $126.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $171.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.91 / $134.88 / $176.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $141.69
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.41 / $143.41 / $176.71