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Missouri rates for HCPCS Q4258

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.54 / $1,751.40 / $1,751.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $91.54 / $107.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $60.90 / $85.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.67 / $84.67 / $89.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $114.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.06 / $120.96 / $700.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.17 / $82.41 / $1,668.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.75 / $89.75 / $89.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.96 / $89.75 / $109.76