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Montana rates for HCPCS Q4175

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.45 / $99.78 / $106.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.26 / $78.26 / $78.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.38 / $78.26 / $91.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.26 / $86.30 / $91.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.26 / $99.31 / $99.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54