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Montana rates for HCPCS Q4134

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.66 / $134.52 / $134.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.08 / $162.08 / $185.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.08 / $162.08 / $185.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.66 / $162.08 / $162.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.08 / $175.84 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.08 / $162.08 / $162.08