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Montana rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $37.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $30.20 / $42.66
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $32.36 / $60.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $60.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $33.11 / $181.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $79.43 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $125.89 / $125.89