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Indiana 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 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $11.75 / $12.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $223.87 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $28.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $17.78 / $23.99
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 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $36.31 / $125.89