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Maryland rates for HCPCS Q4102

Oasis wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $14.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.33 / $9.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $11.75 / $30.90
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
$28.84 / $138.04 / $194.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $13.49 / $13.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $30.90 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $158.49 / $204.17