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Missouri rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.56 / $15.00 / $15.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.54 / $2.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $9.81 / $11.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.35 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $3.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $3.77 / $15.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.48 / $5,398.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $3.59