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Kentucky rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,729.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $5,169.00 / $5,907.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $4,061.35 / $5,353.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,929.02 / $2,929.02 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $5,143.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $3,807.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,954.28