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Montana rates for HCPCS Q4216

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $125.89 / $144.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $181.97 / $309.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89