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Montana rates for HCPCS Q4187

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $295.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $281.84 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $281.84 / $346.74
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $478.63
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $478.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $281.84 / $416.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $223.87 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $165.96 / $269.15