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Maryland rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $45.25 / $45.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.02 / $11.02 / $11.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,780.25 / $3,780.25 / $4,200.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $46.80