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Montana rates for HCPCS Q4217

WoundFix, BioWound, WoundFix Plus, BioWound Plus, WoundFix Xplus or BioWound Xplus, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $316.23 / $446.68
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,513.56
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,513.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $316.23 / $776.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $165.96 / $1,445.44