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Missouri rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $73.70 / $109.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $72.98 / $85.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.45 / $16.16 / $29.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $67.50 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $91.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $104.18 / $171.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $395.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.97 / $71.55 / $82.50