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Montana rates for HCPCS Q4151

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

Facilitymedian $148 · 10th–90th $135–$2290%50%10th90th$148Professionalmedian $135 · 10th–90th $132–$1700%50%10th90th$135$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $154.88 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $147.91 / $257.04
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $147.91 / $257.04
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $154.88 / $251.19
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $128.82 / $239.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89