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Montana rates for HCPCS Q4209

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

Facilitymedian $178 · 10th–90th $115–$3470%10%10th90th$178Professionalmedian $126 · 10th–90th $100–$1550%20%40%10th90th$126$100.0$200.0$500.0

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
$100.00 / $125.89 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $181.97
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $177.83 / $346.74
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89