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Montana rates for HCPCS Q4227

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.28 / $1,278.08 / $1,360.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,361.25 / $1,361.25 / $1,361.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.56 / $1,361.25 / $1,361.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.56 / $1,207.73 / $1,361.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,246.56 / $1,272.11 / $1,659.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.56 / $1,172.56 / $1,172.56