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Virginia rates for HCPCS Q4102

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

Facilitymedian $12 · 10th–90th $11$430%20%10th90th$12Professionalmedian $12 · 10th–90th $11$650%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 / $12.02
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
$28.84 / $28.84 / $53.70
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $18.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $131.83 / $239.88
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.37 / $4.37 / $4.37
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $12.88 / $22.39
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.22 / $12.88 / $17.38
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.22 / $12.88 / $17.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $19.95 / $25.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $125.89 / $125.89