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Missouri rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $93.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $109.65 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $85.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $102.33 / $245.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $85.11 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $128.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $83.18 / $125.89