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Montana rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.26 / $723.35 / $769.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.17 / $821.17 / $821.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $821.17 / $821.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $821.17 / $1,076.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.97 / $719.97 / $1,073.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63