go back

Vermont rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $281.84 / $302.00