go back

MemoDerm, DermaSpan, TranZgraft or InteguPly

Montana rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

How much does MemoDerm, DermaSpan, TranZgraft or InteguPly cost?

$79.43

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $79.43 for this service. The price depends on where it is billed: about $72.44 from a physician practice, and about $95.50 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$72.44$67.61 to $110
FacilityA hospital or hospital-owned outpatient department$95.50$93.33 to $112

How much rates vary

Facilitymedian $95 · 10th to 90th $72 to $151Professionalmedian $72 · 10th to 90th $63 to $126
$100$200facility $95professional $72

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$69.18
Typical High
$87.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$125.89
Typical High
$125.89
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$95.50
Typical High
$151.36
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$95.50
Typical High
$151.36
Providence
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$72.44
Typical High
$181.97
Providence
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$79.43
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Montana sits

The same service costs 2.0 times more in Alaska than in Arkansas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 9th of 51

$79.43

AK $126AR $63.10

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.