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Montana rates for HCPCS Q4226

MyOwn Skin, includes harvesting and preparation procedures, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.00 / $1,195.20 / $1,195.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.19 / $441.19 / $1,224.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.31 / $1,224.00 / $1,224.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.49 / $386.49 / $1,500.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.31 / $1,440.00 / $2,100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,200.00