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Kentucky rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $660.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $588.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $891.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $588.84 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $4,265.80 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $3,801.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,290.87 / $2,691.53