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Kansas rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $101.13 / $101.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $80.90 / $101.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.13 / $89.74 / $95.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.07 / $89.07 / $89.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $130.00 / $130.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $101.13 / $113.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $844.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $136.47