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Maryland rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $871.37 / $871.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,105.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.79 / $277.79 / $277.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,340.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.96 / $897.54 / $1,052.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,095.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.18 / $300.18 / $1,379.29