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Montana rates for HCPCS Q4143

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.26 / $36.97 / $39.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.72 / $38.72 / $38.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $38.72 / $38.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.92 / $37.10 / $38.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.79 / $36.79 / $40.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92