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Connecticut 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
$12.02 / $33.11 / $33.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $14.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.90 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $14.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $114.82 / $125.89