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Missouri rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,318 · 10th–90th $107–$2,1880%10%10th90th$1,318Professionalmedian $1,230 · 10th–90th $110–$1,4790%20%10th90th$1,230$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,288.25 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,479.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $1,548.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $151.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,513.56 / $3,388.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,202.26 / $5,128.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $1,412.54 / $1,548.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $1,047.13