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Montana rates for HCPCS Q4257

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$924.24 / $997.44 / $1,061.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.99 / $564.99 / $564.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.97 / $564.99 / $915.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.99 / $702.35 / $915.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.99 / $992.78 / $992.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $915.09