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Maryland rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.00 / $85.00 / $85.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.83 / $144.83 / $160.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.82 / $160.91 / $169.77