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Connecticut rates for HCPCS Q4124

OASIS ultra tri-layer 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
$2.59 / $2.59 / $4.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.58 / $2.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.59 / $2.59 / $3.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.49 / $2.61