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Georgia 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
$1,902.62 / $1,902.62 / $1,902.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,997.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,940.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $3,729.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.93 / $1,794.93 / $1,902.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,423.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,295.00 / $2,295.00 / $2,295.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.97 / $239.19 / $3,519.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,663.36