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Alaska rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $5 · 10th–90th $3–$1580%20%10th90th$5Professionalmedian $2 · 10th–90th $2–$3020%50%90th$2$2.0$10.0$50.0$200.0$1.0K$5.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $3.98 / $158.49
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.72 / $23.99 / $52.48
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $16.60 / $18.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $4.57 / $158.49
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $107.15 / $323.59