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Missouri rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $1,260.00 / $1,260.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,020.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $960.00 / $960.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $1,200.00 / $2,323.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $4,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.87 / $788.99 / $909.71