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Missouri rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.22 / $2,520.00 / $2,520.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $2,000.22 / $2,353.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,311.29 / $1,663.17 / $2,172.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.00 / $1,850.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,497.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,920.00 / $2,353.19 / $4,887.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $6,720.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,333.59