go back

Montana rates for HCPCS Q4107

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

Facilitymedian $123 · 10th–90th $93$1620%20%10th90th$123Professionalmedian $83 · 10th–90th $79$1260%50%10th90th$83$100.0$200.0$500.0

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
$79.43 / $83.18 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $144.54 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $117.49 / $125.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $123.03 / $128.82
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $123.03 / $128.82
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $114.82 / $204.17
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $114.82 / $158.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89