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Zenith Amniotic Membrane

Montana rates for HCPCS Q4253

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

Rates data updated July 2026.

How much does Zenith Amniotic Membrane cost?

$87.10

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $87.10 for this service. The price depends on where it is billed: about $83.18 from a physician practice, and about $257 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$83.18$77.62 to $224
FacilityA hospital or hospital-owned outpatient department$257$182 to $302

How much rates vary

Facilitymedian $257 · 10th to 90th $81 to $912Professionalmedian $83 · 10th to 90th $76 to $363
$100$200$500$1K$2Kfacility $257professional $83

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$83.18
Typical High
$616.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$125.89
Typical High
$125.89
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$912.01
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$912.01
Providence
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$83.18
Typical High
$467.74
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$81.28
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Montana sits

The same service costs 2.5 times more in Alaska than in Maryland. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 12th of 51

$87.10

AK $191MD $75.86

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.