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Ohio 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 / $2,481.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,959.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $2,188.01 / $3,694.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,872.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,568.54
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 / $2,692.39
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,349.92 / $2,349.92 / $2,349.92
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,700.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,092.88 / $2,242.35 / $2,584.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,431.55