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Montana rates for HCPCS Q4225

AmnioBind or DermaBind TL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,441.72 / $1,555.92 / $1,655.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,583.37 / $1,583.37 / $1,583.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,583.37 / $1,583.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,427.45 / $1,583.37 / $1,824.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,504.86 / $1,548.65 / $2,019.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,427.45