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Montana rates for HCPCS Q4138

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.09 / $106.94 / $113.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.11 / $107.59 / $107.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.11 / $107.59 / $107.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.11 / $107.59 / $294.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.26 / $106.43 / $282.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.11 / $98.11 / $98.11