go back

Montana rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.92 / $106.75 / $367.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.35 / $114.35 / $114.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $114.35 / $114.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $114.35 / $206.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.26 / $106.26 / $198.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94