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Montana rates for HCPCS Q4258

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.64 / $97.82 / $104.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.98 / $81.98 / $81.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.91 / $81.98 / $89.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.98 / $89.75 / $91.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.22 / $97.37 / $118.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $89.75