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Montana rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.53 / $31.14 / $105.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.65 / $34.65 / $90.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $34.65 / $34.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $36.54 / $45.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.79 / $32.79 / $38.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23