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Missouri rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.88 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $18.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $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
$12.02 / $12.02 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $18.20 / $46.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $14.45 / $67.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $16.60 / $19.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.88 / $125.89