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Kentucky rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.00 / $81.00 / $81.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.90 / $41.06 / $41.07
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00