go back

Kentucky rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $22.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $22.95 / $23.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $16.91 / $22.95
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.53 / $321.10 / $583.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.79 / $291.91 / $423.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $24.39 / $24.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.98 / $224.87 / $291.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.82 / $28.69 / $29.55