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Montana rates for HCPCS Q4159

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.00 / $223.40 / $237.75
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
$300.14 / $300.14 / $300.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $300.14 / $300.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.96 / $300.14 / $329.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.35 / $222.35 / $329.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.96 / $204.96 / $204.96