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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
$10.96 / $12.02 / $14.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $12.02 / $15.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $97.72 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.75 / $11.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $12.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $14.79 / $38.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $11.75 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $19.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $30.20 / $125.89