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Montana rates for HCPCS Q4163

Woundex Bioskin Per Square Centimeter (Desc Revised 1/1/2018)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.00 / $198.58 / $211.33
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
$205.52 / $205.52 / $205.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.18 / $205.52 / $205.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.18 / $205.52 / $225.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.65 / $197.65 / $257.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.18 / $182.18 / $182.18