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Montana rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,019.95 / $3,630.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $3,162.28 / $3,162.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,023.29
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,023.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $2,951.21 / $4,570.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $165.96 / $3,235.94