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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
Facility
Modifier
Low / Median / High Price
$11.70 / $11.70 / $11.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $13.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.36 / $9.36 / $9.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $11.48 / $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
$9.50 / $11.88 / $13.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.47
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.07 / $12.07 / $15.56