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Missouri rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.11 / $315.00 / $315.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $72.11 / $84.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.16 / $171.83 / $231.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $66.69 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $90.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.45 / $108.10 / $300.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $71.04 / $453.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.47 / $98.47 / $121.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.63 / $70.70 / $86.47