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Kansas 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
$2.00 / $2.00 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.51 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $3.47 / $15.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $5,370.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $13.80 / $16.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $12.59 / $125.89