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California rates for HCPCS Q4139

AmnioMatrix or BioDMatrix, injectable, 1 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,820.00 / $1,820.00 / $1,820.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.00 / $1,820.00 / $1,820.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.26 / $199.48 / $424.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.00 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $1,820.00 / $4,076.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00