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Vermont rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $22.91 / $24.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $24.55 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $66.07 / $125.89