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Montana rates for HCPCS Q4204

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

Facilitymedian $3,311 · 10th–90th $204–$4,5710%20%10th90th$3,311Professionalmedian $3,715 · 10th–90th $126–$4,0740%50%10th90th$3,715$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
$3,715.35 / $3,715.35 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $3,311.31
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $3,548.13 / $4,570.88
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $3,548.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89