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Ohio rates for HCPCS Q4102

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

Facilitymedian $13 · 10th–90th $11$2750%10%20%10th90th$13Professionalmedian $12 · 10th–90th $11$1150%20%10th90th$12$2.0$5.0$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $13.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $15.14 / $63.10
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $16.22
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.22 / $11.22 / $11.75
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $16.98
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $91.20 / $131.83
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $36.31 / $63.10
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $125.89 / $125.89