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Maryland rates for HCPCS Q4159

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.17 / $235.17 / $235.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $225.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.16 / $620.16 / $620.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.96 / $204.96 / $1,076.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $261.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.22 / $204.96 / $1,139.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $217.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.35 / $263.35 / $268.50