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Missouri rates for HCPCS Q4164

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,638.00 / $1,638.00 / $1,690.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,673.75 / $1,969.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.33 / $1,309.34 / $1,710.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.05 / $1,548.05 / $1,640.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $2,089.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,363.09 / $1,791.57 / $4,067.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.84 / $1,640.93 / $5,857.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.04 / $1,640.93 / $1,898.56