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Montana rates for HCPCS Q4235

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.86 / $95.89 / $102.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $108.36 / $108.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.98 / $108.36 / $118.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.45 / $95.45 / $163.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98