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Montana rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.93 / $42.01 / $44.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.62 / $57.62 / $122.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $57.62 / $57.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.11 / $38.54 / $62.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.81 / $41.81 / $57.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54