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Montana rates for HCPCS Q4161

bio-ConneKt wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,606.45 / $1,733.69 / $1,845.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,115.96 / $2,115.96 / $2,115.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.54 / $2,115.96 / $2,115.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,590.54 / $2,115.96 / $2,319.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,725.59 / $1,725.59 / $2,250.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.54 / $1,590.54 / $1,590.54