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Missouri rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $57.13 / $2,855.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.83 / $57.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $37.18 / $41.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $28.52 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $38.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.91 / $46.11 / $75.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $30.30 / $2,212.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $37.70