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Montana rates for HCPCS Q4108

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

Facilitymedian $52 · 10th–90th $40–$1230%20%40%10th90th$52Professionalmedian $40 · 10th–90th $38–$1260%20%40%10th90th$40$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
$38.02 / $38.02 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $61.66 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $52.48 / $87.10
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $52.48 / $87.10
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $51.29 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $74.13 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89