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Montana rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $145 · 10th–90th $91–$2570%10%10th90th$145Professionalmedian $126 · 10th–90th $98–$1550%20%40%10th90th$126$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
$97.72 / $125.89 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $181.97
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $141.25 / $257.04
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89