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Montana rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $85 · 10th–90th $78–$1510%20%40%10th90th$85Professionalmedian $79 · 10th–90th $78–$1260%20%40%10th90th$79$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
$77.62 / $77.62 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $83.18 / $151.36
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $83.18 / $151.36
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $95.50 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $95.50 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89