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Montana rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.84 / $82.94 / $88.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.57 / $98.57 / $98.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $98.57 / $98.57
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $98.57 / $106.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.55 / $82.55 / $115.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09