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California rates for HCPCS Q4124

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

Facilitymedian $16 · 10th–90th $13$740%20%40%10th90th$16Professionalmedian $9 · 10th–90th $2$1350%20%40%10th90th$9$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $41.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $41.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $16.22 / $40.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $12.88 / $23.99
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $20.89 / $28.84
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.13 / $11.48 / $23.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $177.83 / $239.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $165.96 / $269.15
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,370.32 / $5,370.32 / $5,370.32
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $10.23 / $10.23
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $3.89 / $204.17
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $125.89 / $125.89
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $13.80 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $125.89 / $151.36