go back

Mississippi rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.82 / $912.12 / $7,588.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $26.44 / $37.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.34 / $36.34 / $39.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.00 / $37.00 / $37.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $32.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.41 / $31.11 / $40.44