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Washington 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
$12.88 / $281.84 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $12.02 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.22 / $23.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $12.88
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $23.99 / $380.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $23.44 / $33.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $33.11 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $11.75 / $17.78
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $6.17 / $12.30
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $13.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.91 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $154.88 / $257.04