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Wyoming 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
$2,038.50 / $2,038.50 / $2,038.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $2,073.86 / $2,092.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,295.00 / $2,700.00 / $2,700.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.93 / $1,794.93 / $1,794.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $2,692.39 / $2,692.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,902.62