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Missouri rates for HCPCS Q4107

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

Facilitymedian $107 · 10th–90th $79$2240%20%10th90th$107Professionalmedian $85 · 10th–90th $79$1380%50%10th90th$85$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $83.18 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $109.65 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $144.54 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $223.87 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $100.00 / $218.78
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $138.04 / $851.14
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $181.97 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $125.89 / $138.04