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Montana rates for HCPCS Q4111

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

Facilitymedian $8 · 10th–90th $7–$220%20%40%10th90th$8Professionalmedian $8 · 10th–90th $7–$1170%50%10th90th$8$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
$7.08 / $7.08 / $33.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.71 / $10.47 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $8.71 / $125.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.24 / $7.59 / $14.45
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.24 / $7.59 / $14.45
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.41 / $8.71 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $14.13 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89