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Missouri rates for HCPCS Q4253

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

Facilitymedian $102 · 10th–90th $78–$1,2020%10%10th90th$102Professionalmedian $81 · 10th–90th $76–$1550%20%40%10th90th$81$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $77.62 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $89.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $109.65 / $501.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $144.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $117.49 / $1,148.15
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $83.18 / $1,318.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $102.33 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $134.90