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Kentucky rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $98.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $115.50 / $210.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $137.12 / $156.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $107.73 / $142.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $175.44 / $175.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $147.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $140.00 / $189.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $111.01