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Maryland rates for HCPCS Q4257

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.66 / $652.66 / $652.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $960.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.00 / $595.00 / $595.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.09 / $915.09 / $915.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $1,165.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.83 / $915.09 / $1,500.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $1,164.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.66 / $915.09 / $1,198.77