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Kentucky rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,230 · 10th–90th $1,230–$1,7380%50%90th$1,230Professionalmedian $1,230 · 10th–90th $398–$1,2880%50%10th90th$1,230$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,288.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,995.26
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,318.26 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $5,248.07
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $1,737.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,047.13