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Montana rates for HCPCS Q4234

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.47 / $603.79 / $642.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.99 / $282.99 / $282.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.95 / $282.99 / $553.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.99 / $553.94 / $570.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.99 / $600.97 / $705.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.94 / $553.94 / $553.94