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Texas 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
$11.88 / $11.88 / $12.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.24 / $30.00 / $59.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.37 / $13.37 / $13.37
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.21 / $11.88 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.16 / $1,591.16 / $1,591.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $11.70 / $25.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $14.85
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.90 / $16.52 / $148.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $11.88 / $21.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $14.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $11.88 / $16.04