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Ohio rates for HCPCS Q4117

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

Facilitymedian $65 · 10th–90th $22$3160%20%10th90th$65Professionalmedian $23 · 10th–90th $17$1170%20%10th90th$23$2.0$5.0$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
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $21.88 / $21.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $22.91 / $23.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $21.88 / $66.07
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $346.74
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $33.11 / $131.83
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $34.67 / $60.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $125.89 / $125.89