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Maryland rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $1,789.55 / $1,789.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,068.38
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.00 / $306.00 / $306.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,508.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,674.41 / $1,969.89 / $2,431.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,702.16 / $2,702.16 / $2,702.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,078.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.55 / $1,969.89 / $2,580.56