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Montana rates for HCPCS Q4203

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

Facilitymedian $316 · 10th–90th $234–$1,0470%20%10th90th$316Professionalmedian $1,047 · 10th–90th $166–$1,1480%50%10th90th$1,047$100.0$200.0$500.0$1.0K$2.0K

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
$912.01 / $1,047.13 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $204.17 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $323.59
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $316.23 / $407.38
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $316.23 / $407.38
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $1,047.13 / $1,318.26
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $371.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89