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Missouri rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.31 / $1,197.00 / $1,197.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $77.31 / $90.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.02 / $448.26 / $603.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $71.50 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $96.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.84 / $126.57 / $1,140.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.86 / $83.18 / $1,311.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $94.51