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Montana rates for HCPCS Q4218

Surgicord Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $124.50 / $124.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $150.00 / $150.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00