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Missouri rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,951.21 / $3,162.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $109.65 / $151.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,445.44 / $3,630.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,235.94 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $4,786.30 / $5,248.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,230.27 / $3,235.94