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Missouri rates for HCPCS Q4250

AmnioAmp-MP, 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 / $3,019.95 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $3,311.31
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
$2,818.38 / $2,818.38 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,630.78 / $8,709.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,884.03 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,570.40 / $2,884.03