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Montana rates for HCPCS Q4164

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

Facilitymedian $1,660 · 10th–90th $372–$2,6300%20%40%10th90th$1,660Professionalmedian $1,622 · 10th–90th $158–$1,9500%50%10th90th$1,622$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$1,621.81 / $1,621.81 / $1,949.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $371.54 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $371.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $2,630.27
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $2,630.27
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $1,659.59 / $2,041.74
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $562.34
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89