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Missouri rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.90 / $1,047.90 / $1,084.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,073.94 / $1,263.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.54 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.29 / $993.29 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,340.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.83 / $987.26 / $2,039.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.23 / $871.37 / $1,325.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.32 / $1,052.89 / $1,218.19