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Missouri rates for HCPCS Q4151

AmnioBand or Guardian, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $138.93 / $138.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $137.58 / $161.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.15 / $134.88 / $189.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.25 / $127.25 / $134.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $171.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.84 / $181.54 / $341.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.84 / $137.19 / $633.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.19 / $134.88 / $155.12