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Montana rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.69 / $715.18 / $761.10
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
$1,175.91 / $1,175.91 / $1,175.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $1,175.91 / $1,175.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $675.81 / $1,175.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.99 / $711.83 / $1,175.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12