go back

Montana rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.27 / $77.98 / $83.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.68 / $81.68 / $81.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $81.68 / $81.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $73.70 / $83.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $77.63 / $83.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55