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Montana rates for HCPCS Q4184

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.84 / $87.24 / $92.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.37 / $91.37 / $91.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $91.37 / $91.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.04 / $91.37 / $780.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.84 / $86.84 / $749.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $80.04 / $80.04