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Montana rates for HCPCS Q4117

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

Facilitymedian $30 · 10th–90th $9–$630%20%40%10th90th$30Professionalmedian $23 · 10th–90th $22–$1170%20%40%10th90th$23$10.0$20.0$50.0$100.0$200.0

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
$21.88 / $22.91 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $144.54 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $29.51 / $33.11
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $29.51 / $33.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $27.54 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $79.43 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89