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Wyoming rates for HCPCS Q4107

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

Facilitymedian $240 · 10th–90th $129–$4790%20%40%10th90th$240Professionalmedian $85 · 10th–90th $79–$1380%50%10th90th$85$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $81.28 / $100.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $85.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $138.04