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Missouri rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $213.80 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $102.33 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $109.65 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $114.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $144.54 / $316.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $97.72 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $125.89 / $165.96