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Montana rates for HCPCS Q4114

Integra flowable wound matrix, injectable, 1 cc

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.35 / $1,628.91 / $1,733.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,705.81 / $1,705.81 / $1,705.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,494.41 / $1,705.81 / $1,705.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.21 / $1,494.41 / $1,705.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.22 / $1,621.29 / $2,114.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,494.41 / $1,494.41 / $1,494.41