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Matrion

Pennsylvania rates for HCPCS Q4201

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

Rates data updated July 2026.

Facilitymedian $78 · 10th–90th $76$4680%50%10th90th$78Professionalmedian $78 · 10th–90th $76$1510%50%10th90th$78$100.0$500.0$2.0K$10.0K$50.0K

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
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$83.18
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$275.42
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$263.03
Typical High
$288.40
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$218.78
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$77.62
Typical High
$77.62
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$79.43
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$199.53
Typical High
$199.53
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$213.80