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Montana rates for HCPCS Q4141

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

Facilitymedian $49 · 10th–90th $44–$1450%20%40%10th90th$49Professionalmedian $107 · 10th–90th $79–$1290%20%40%10th90th$107$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
$107.15 / $107.15 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $77.62
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $77.62
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $109.65 / $199.53
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $79.43 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89