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Montana rates for HCPCS Q4176

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.00 / $157.69 / $157.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.25 / $75.25 / $161.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.52 / $161.50 / $161.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.92 / $65.92 / $203.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.52 / $195.12 / $284.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.51 / $167.51 / $167.51