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Restorigin

Montana rates for HCPCS Q4191

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

Rates data updated July 2026.

Facilitymedian $1,622 · 10th–90th $661$2,0890%20%10th90th$1,622Professionalmedian $724 · 10th–90th $126$2,0890%20%10th90th$724$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
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$724.44
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$1,071.52
Typical High
$1,071.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$1,071.52
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$2,290.87
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$2,290.87
Providence
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$676.08
Typical High
$1,258.93
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$125.89
Typical High
$1,258.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89