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Montana rates for HCPCS Q4147

Architect, Architect PX, or Architect FX, extracellular matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.70 / $47.42 / $47.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.06 / $168.06 / $168.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.56 / $168.06 / $168.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.56 / $147.22 / $184.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.56 / $168.06 / $184.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.13 / $57.13 / $57.13