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Montana rates for HCPCS Q4253

Zenith Amniotic Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $257 · 10th–90th $81–$9120%20%10th90th$257Professionalmedian $78 · 10th–90th $76–$2630%50%10th90th$78$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$75.86 / $75.86 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $912.01
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $912.01
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $83.18 / $467.74
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $81.28 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89