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Kentucky 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 / $12.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.45 / $14.01 / $14.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $16.63 / $19.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $13.07 / $19.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.88 / $16.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.01 / $12.01 / $15.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.72