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Missouri 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
$1,940.67 / $2,835.00 / $2,835.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,940.67 / $2,283.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.16 / $67.42 / $94.96
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.74 / $2,414.61 / $5,081.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,038.50 / $2,038.50 / $10,260.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,326.90