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Montana rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $23.81 / $23.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.30 / $19.30 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.35 / $24.39 / $24.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $16.91 / $35.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.35 / $34.42 / $35.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69