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Kansas rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,995.26 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $1,862.09 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,290.87 / $5,370.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $6,760.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,995.26 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,995.26 / $1,995.26