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Missouri rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.90 / $564.00 / $592.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $108.83 / $397.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.59 / $132.38 / $179.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.66 / $100.66 / $106.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $135.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.97 / $139.74 / $564.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.26 / $89.18 / $1,448.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.57 / $106.70 / $130.49