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Montana rates for HCPCS Q4151

AmnioBand or Guardian, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $147.03 / $431.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.79 / $155.79 / $155.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $155.79 / $155.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $155.79 / $174.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.34 / $146.34 / $174.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88