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Indiana rates for HCPCS Q4124

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

Facilitymedian $245 · 10th–90th $3–$5130%10%10th90th$245Professionalmedian $2 · 10th–90th $2–$150%50%90th$2$2.0$10.0$50.0$200.0

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 / $2.51 / $2.51
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.09 / $263.03 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $12.59
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $3.02 / $4.47
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $125.89 / $125.89