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Montana rates for HCPCS Q4249

Amniply, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,989.59 / $2,147.17 / $2,285.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,787.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,777.50 / $1,969.89 / $2,813.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,706.40 / $2,137.14 / $2,787.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89