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Missouri rates for HCPCS Q4113

GRAFTJACKET XPRESS, injectable, 1 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.00 / $897.50 / $942.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.00 / $718.00 / $762.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.95 / $355.51 / $897.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$762.88 / $762.88 / $762.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.88 / $762.88 / $762.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.00 / $897.50 / $1,737.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,997.50 / $1,997.50 / $3,410.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,957.55 / $1,997.50 / $2,311.11