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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
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $9.33 / $9.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $7.94 / $7.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $12.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $8.51 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $33.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $11.75 / $125.89