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Montana rates for HCPCS Q4141

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.04 / $116.60 / $124.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.22 / $43.22 / $43.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.08 / $43.22 / $106.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.22 / $106.97 / $110.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.22 / $116.05 / $121.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97