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Virginia rates for HCPCS Q4117

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

Facilitymedian $26 · 10th–90th $24–$1260%20%40%10th90th$26Professionalmedian $24 · 10th–90th $22–$780%20%40%10th90th$24$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
$23.99 / $23.99 / $23.99
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $22.91 / $28.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $22.91 / $43.65
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $13.18 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $131.83 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $28.84 / $44.67
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $28.84 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $28.84 / $42.66
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $28.84 / $42.66
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $48.98 / $64.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $125.89 / $125.89