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Wisconsin rates for HCPCS Q4117

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

Facilitymedian $26 · 10th–90th $17$890%20%10th90th$26Professionalmedian $24 · 10th–90th $22$1660%50%10th90th$24$5.0$20.0$100.0$500.0$2.0K

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 / $28.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $28.84 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $42.66 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.38 / $125.89 / $223.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $22.91 / $35.48
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $22.91 / $79.43
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $28.84 / $109.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $17.78 / $17.78
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $223.87 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $64.57 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $128.82
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $28.18 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $70.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $125.89 / $134.90