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Arizona rates for HCPCS Q4239

Amnio-Maxx or Amnio-Maxx Lite, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,092.88 / $2,092.88 / $2,092.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,921.65 / $2,092.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,894.98 / $4,476.88 / $11,071.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,924.59 / $2,368.71 / $5,596.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.93 / $1,902.62 / $1,902.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,902.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.00 / $2,364.66 / $4,551.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,038.50 / $2,038.50 / $4,423.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,902.62