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Kentucky rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,989.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $2,757.85 / $3,151.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,166.88 / $2,856.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $2,296.02 / $2,296.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.55 / $1,969.89 / $2,701.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $2,048.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,109.75