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Missouri rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $575.44 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $562.34 / $776.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $109.65 / $173.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $660.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $3,311.31 / $6,760.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,818.38 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,454.71 / $2,818.38