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Missouri rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.59 / $55.90 / $55.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $42.59 / $45.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.37 / $42.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.97 / $46.00 / $103.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $136.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $52.79