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Montana rates for HCPCS Q4125

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.74 / $138.91 / $138.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $138.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $1,800,000.00 / $2,250,000.00