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Washington, DC 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
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $13.49
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.33 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.75 / $11.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $13.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $32.36 / $141.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $48.98 / $125.89