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Missouri rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,009.28 / $2,836.26 / $2,836.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,009.28 / $2,363.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,858.38 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,508.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.00 / $2,147.44 / $4,187.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.55 / $1,789.55 / $9,454.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,409.17