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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
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $14.13
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $14.13 / $14.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $12.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $11.75 / $19.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $12.59 / $16.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $50.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $16.60 / $16.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $36.31 / $125.89