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Maryland 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
$2,901.66 / $2,901.66 / $2,901.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,128.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $3,794.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,532.62 / $2,569.84 / $2,979.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,949.76 / $2,979.56 / $3,099.93
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,901.66 / $2,979.56 / $3,903.22