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Montana rates for HCPCS Q4235

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

Facilitymedian $158 · 10th–90th $107–$2630%20%40%10th90th$158Professionalmedian $91 · 10th–90th $87–$1660%20%40%10th90th$91$100.0$200.0$500.0

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
$87.10 / $87.10 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $288.40
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $288.40
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $107.15 / $263.03
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $107.15 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89