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Montana rates for HCPCS Q4169

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.16 / $2,254.63 / $2,399.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.97 / $200.97 / $2,068.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.00 / $2,068.46 / $2,068.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $3,462.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,244.10 / $3,324.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46