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West Virginia 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
$8.19 / $12.00 / $12.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.00 / $12.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $17.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $27.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.21 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $17.21