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Missouri rates for HCPCS Q4219

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,258.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $977.24 / $1,023.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $109.65 / $138.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,202.26 / $2,630.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $794.33 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,230.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $707.95 / $794.33