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Kentucky rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.92 / $9.28 / $9.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $7.87 / $7.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $11.02 / $12.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.66 / $12.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.87 / $11.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.60 / $7.60 / $9.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.43