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Kentucky rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $15.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $15.14 / $15.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $13.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $20.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $13.80 / $18.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $54.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $18.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $19.50 / $125.89