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Montana rates for HCPCS Q4101

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

Facilitymedian $38 · 10th–90th $31–$1350%20%40%10th90th$38Professionalmedian $31 · 10th–90th $30–$1350%50%10th90th$31$50.0$200.0$1.0K$5.0K$20.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $134.90
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $64,565.42 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $45.71 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $34.67 / $125.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $35.48 / $58.88
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $35.48 / $58.88
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $36.31 / $173.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $60.26 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89