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Minnesota 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
$1,905.46 / $1,905.46 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $2,041.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $3,467.37 / $3,715.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $125.89 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $7,244.36 / $10,232.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,630.27 / $3,019.95
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $7,585.78 / $9,332.54
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $3,630.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,754.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,949.84 / $2,454.71