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Montana rates for HCPCS Q4186

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.10 / $278.10 / $278.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.16 / $166.28 / $2,636.23
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
$180.92 / $180.92 / $180.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.16 / $180.92 / $180.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.16 / $180.92 / $197.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.00 / $164.00 / $198.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.16 / $151.16 / $151.16