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Kentucky rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.89 / $26.13 / $59,421.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $24.89 / $25.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.22 / $36.69 / $36.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.80 / $58.80 / $90.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.79 / $74.06 / $90.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.03 / $31.11 / $42.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $33.32