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Indiana rates for HCPCS Q4250

AmnioAmp-MP, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $3,162.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $380.19 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,951.21 / $4,570.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $4,466.84 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $4,677.35 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,398.83 / $2,818.38