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Missouri rates for HCPCS A4100

Nonsheet form skin substitute, FDA-cleared as a device, not otherwise specified (list in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.07 / $3.07 / $3.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.59 / $4.59 / $4.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $100.00 / $100.00