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Vermont rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.22 / $13.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $30.90 / $125.89