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Montana rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.46 / $531.47 / $565.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.11 / $563.11 / $563.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $563.11 / $563.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $502.21 / $563.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.99 / $528.99 / $867.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59