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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
$12.36 / $19.04 / $33.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.17 / $12.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.33 / $12.56 / $14.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.29 / $11.88 / $12.47