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Maryland 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
$2.48 / $2.48 / $2.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.73
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.48 / $12.48 / $12.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $12.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $3.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.49 / $14.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.26 / $10.22 / $10.22