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Montana rates for HCPCS Q4137

AmnioExcel, AmnioExcel Plus or BioDExcel, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.73 / $110.87 / $296.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.64 / $116.64 / $116.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $116.64 / $116.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.72 / $116.64 / $134.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.35 / $110.35 / $138.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $101.72