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Montana rates for HCPCS Q4153

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.31 / $150.34 / $160.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.19 / $146.19 / $146.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $146.19 / $146.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.93 / $146.19 / $193.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.94 / $149.63 / $195.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93