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Kentucky rates for HCPCS Q4104

Integra bilayer matrix wound dressing (BMWD), per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.51
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.45 / $45.45 / $45.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $71.40 / $81.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $56.10 / $73.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.36 / $51.00 / $73.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $51.78 / $64.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $54.62