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Missouri rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $30.12 / $30.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $22.95 / $24.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $32.61 / $38.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $28.69 / $57.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $109.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.12 / $28.69 / $32.99