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Kansas rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $676.08 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $630.96 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,995.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $724.44 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $851.14 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $724.44 / $1,000.00