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Kentucky 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
$96.80 / $96.80 / $152.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $96.80 / $100.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.21 / $41.29 / $47.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.17 / $90.17 / $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
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $113.30