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Montana rates for HCPCS Q4166

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.17 / $21.77 / $23.17
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
$24.54 / $24.54 / $24.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $24.54 / $24.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.97 / $24.54 / $24.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.67 / $21.67 / $25.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $19.97 / $19.97