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Montana rates for HCPCS Q4148

Neox Cord 1K, Neox Cord RT, or Clarix Cord 1K, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.04 / $134.94 / $143.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.60 / $146.60 / $146.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.80 / $146.60 / $146.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.80 / $146.60 / $161.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.31 / $134.31 / $175.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.80 / $123.80 / $123.80