go back

Maine 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
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $12.88 / $14.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.51 / $3.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $15.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $12.59 / $125.89