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Montana rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $10 · 10th–90th $3–$180%20%40%10th90th$10Professionalmedian $2 · 10th–90th $2–$1170%50%90th$2$2.0$5.0$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
$2.00 / $2.00 / $41.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.47 / $10.47 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.55 / $9.55 / $18.20
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.55 / $9.55 / $18.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $9.33 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $79.43 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89