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Missouri rates for HCPCS Q4133

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.90 / $282.63 / $296.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $141.51 / $268.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $138.74 / $173.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $130.88 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $176.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.90 / $207.22 / $382.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.18 / $136.18 / $1,448.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $169.68