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Missouri rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.90 / $1,050.00 / $1,050.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $676.90 / $796.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.94 / $817.58 / $1,099.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.05 / $626.05 / $663.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $845.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.13 / $1,000.00 / $1,789.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.78 / $717.78 / $3,800.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $827.55