go back

Montana rates for HCPCS Q4140

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.24 / $176.17 / $187.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.62 / $192.83 / $192.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $192.83 / $192.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.62 / $192.83 / $344.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.35 / $175.35 / $345.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $161.62 / $161.62