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Maine rates for HCPCS Q4124

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

Facilitymedian $145 · 10th–90th $145$3630%50%90th$145Professionalmedian $2 · 10th–90th $2$130%50%90th$2$2.0$5.0$10.0$20.0$50.0$100.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.00
Typical High
$3.39
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.88
Typical High
$12.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.02
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.00
Typical High
$10.00
United
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$10.96
Typical High
$125.89