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Mississippi rates for HCPCS Q4209

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.25 / $55.25 / $55.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $25.00 / $50.00