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Maryland rates for HCPCS Q4248

Dermacyte amniotic membrane allograft, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,824.50 / $2,824.50 / $2,824.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $644.03
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.00 / $1,003.00 / $1,003.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.20 / $555.20 / $555.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $707.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.92 / $555.20 / $2,427.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $610.54
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $2,824.50