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Mississippi rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.93 / $82.93 / $121.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $85.96 / $121.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.00 / $102.00 / $112.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.00 / $102.00 / $102.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $99.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.65 / $136.47 / $177.41