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Montana rates for HCPCS Q4188

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

Facilitymedian $676 · 10th–90th $490–$8320%20%40%10th90th$676Professionalmedian $490 · 10th–90th $158–$6030%50%10th90th$490$100.0$200.0$500.0$1.0K

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
$489.78 / $489.78 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $562.34 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $562.34
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $676.08 / $831.76
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $676.08 / $831.76
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $512.86 / $954.99
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $562.34
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89