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Kansas rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,071.52 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $1,000.00 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $1,000.00 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $794.33 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $302.00 / $1,000.00