go back

Missouri rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $10.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $109.65 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $10.00 / $22.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $7.08 / $32.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $10.23 / $12.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.94 / $125.89