go back

Oregon 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
$24.39 / $24.39 / $24.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $23.81 / $28.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $48.78 / $48.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $175.00 / $194.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $23.81 / $37.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.32 / $16.91 / $16.91
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $16.91 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $26.19 / $51.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $35.85 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $32.99