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Missouri rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.38 / $497.70 / $497.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $113.38 / $133.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $115.34 / $349.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.86 / $104.86 / $111.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $141.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.86 / $198.21 / $474.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.26 / $130.26 / $1,606.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $135.94