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Montana rates for HCPCS Q4102

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

Facilitymedian $13 · 10th–90th $8–$320%20%10th90th$13Professionalmedian $12 · 10th–90th $11–$1170%20%10th90th$12$5.0$10.0$20.0$50.0$100.0$200.0

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
$10.96 / $12.02 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.80 / $16.22 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $14.45 / $125.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.32 / $13.18 / $26.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $13.18 / $26.30
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.94 / $13.80 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $20.89 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89