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Montana rates for HCPCS Q4229

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.97 / $502.88 / $535.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.52 / $572.52 / $572.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.36 / $572.52 / $572.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.36 / $572.52 / $651.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.53 / $500.53 / $1,123.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.36 / $461.36 / $461.36