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Missouri rates for HCPCS Q4254

Novafix DL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $366.55 / $391.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.00 / $340.00 / $448.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $480.00 / $634.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $1,824.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.40 / $480.00 / $571.20