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Missouri rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.75 / $2,331.00 / $2,331.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $749.75 / $882.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.21 / $926.28 / $1,246.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.44 / $693.44 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $936.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$829.48 / $1,127.93 / $2,286.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.21 / $813.21 / $8,436.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $898.97