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Pennsylvania 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
$1,807.44 / $1,969.89 / $4,724.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,989.59
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,674.41 / $1,969.89 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
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 / $1,969.89
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,858.38 / $1,969.89 / $2,044.22
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,807.44 / $1,969.89 / $4,724.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,989.59
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,969.89 / $1,969.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,137.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,702.16