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Montana rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.95 / $73.33 / $78.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.62 / $72.62 / $72.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $72.62 / $72.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $72.62 / $94.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.02 / $72.98 / $97.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27