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Maryland rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,096.48
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $186.21 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $302.00 / $1,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $186.21 / $302.00