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Montana rates for HCPCS Q4123

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

Facilitymedian $66 · 10th–90th $25–$1150%20%40%10th90th$66Professionalmedian $71 · 10th–90th $71–$1260%50%90th$71$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
$70.79 / $70.79 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $81.28 / $125.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $66.07 / $74.13
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $66.07 / $74.13
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $81.28 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $81.28 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89