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Montana rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $37.29 / $111.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $48.40 / $66.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $45.22 / $48.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.96 / $44.94 / $51.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.78 / $45.22 / $48.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $50.94