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Maryland rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.04 / $71.04 / $71.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $77.77
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.00 / $255.00 / $255.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $90.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.10 / $70.70 / $273.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $74.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.64 / $72.64 / $92.62