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Missouri rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.96 / $35.96 / $35.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $35.96 / $38.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.11 / $41.66 / $48.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $57.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.96 / $48.57 / $87.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $1,816.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.92 / $50.94 / $58.73