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TheraSkin

Montana rates for HCPCS Q4121

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

Rates data updated July 2026.

Facilitymedian $52 · 10th–90th $28$1350%20%10th90th$52Professionalmedian $58 · 10th–90th $49$1260%20%10th90th$58$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
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$57.54
Typical High
$66.07
Cigna
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$58.88
Typical High
$125.89
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$48.98
Typical High
$87.10
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$48.98
Typical High
$87.10
Providence
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$58.88
Typical High
$204.17
Providence
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$79.43
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89