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Montana rates for HCPCS Q4254

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.43 / $359.43 / $412.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.23 / $406.23 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.09 / $408.00 / $408.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $600.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.09 / $408.00 / $776.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00