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Montana rates for HCPCS Q4100

Skin Substitute, Nos

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $38.59 / $38.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $79,999.99 / $94,999.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.40 / $125.40 / $125.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.40 / $125.40 / $2,250,000.00