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Kansas rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.62 / $10,353.96 / $31,193.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $96.80 / $121.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.45 / $33.33 / $37.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $172.00 / $172.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.80 / $121.00 / $144.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $459.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $123.83