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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
$11.88 / $11.88 / $11.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.36 / $9.36 / $9.36
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 / $15.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.10 / $10.10 / $12.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $19.25