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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
$1,412.54 / $1,412.54 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,584.89 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,584.89 / $2,041.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $1,445.44 / $2,398.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,584.89 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $165.96 / $1,445.44