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Mississippi 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 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $13.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $15.49 / $125.89