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Montana rates for HCPCS Q4239

Amnio-Maxx or Amnio-Maxx Lite, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,921.65 / $2,073.86 / $2,207.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,682.46 / $2,682.46 / $2,682.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $2,682.46 / $2,682.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.62 / $2,682.46 / $2,812.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,064.17 / $2,064.17 / $2,957.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,902.62