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Kentucky rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $72.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.00 / $84.38 / $84.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.54 / $71.55 / $71.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $100.17 / $114.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $78.70 / $103.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $88.55 / $88.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $101.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $93.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.40 / $71.55 / $76.63