go back

Montana rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.85 / $714.28 / $760.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,073.20 / $1,073.20 / $1,073.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $1,073.20 / $1,073.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $1,073.20 / $1,270.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.94 / $710.94 / $1,515.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29