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Missouri 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 / $13.50 / $14.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.12 / $14.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.15 / $8.21 / $13.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.21 / $11.21 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $15.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.94 / $15.33 / $30.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $11.70 / $1,591.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $13.66