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Montana rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.06 / $71.29 / $161.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.01 / $74.66 / $128.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $74.66 / $74.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.22 / $65.41 / $81.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.95 / $70.95 / $92.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41