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Montana rates for HCPCS Q4115

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

Facilitymedian $21 · 10th–90th $10–$400%20%10th90th$21Professionalmedian $13 · 10th–90th $12–$1170%20%40%10th90th$13$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
$12.02 / $12.02 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $33.11 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $18.62 / $125.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.47 / $20.89 / $23.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $20.89 / $23.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $14.13 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $60.26 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89