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California rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $12.00 / $35.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.00 / $35.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.40 / $13.58 / $22.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.28 / $11.88 / $27.47
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.21 / $19.91 / $27.63
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.80 / $4.00 / $12.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.21 / $11.21 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $13.50
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.80 / $12.07 / $16.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.69 / $14.85 / $26.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.16 / $1,591.16 / $1,591.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.78 / $24.74 / $24.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.38 / $11.88 / $19.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $15.31
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.18 / $23.18 / $23.18
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.51 / $9.80 / $13.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $22.82