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Kentucky rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $112.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $317.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $155.61 / $177.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $122.27 / $161.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $402.90 / $402.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $317.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.59 / $332.42 / $432.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $130.26