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Pennsylvania rates for HCPCS Q4124

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

Facilitymedian $4 · 10th–90th $2$4470%20%10th90th$4Professionalmedian $2 · 10th–90th $2$1260%50%90th$2$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.51 / $4.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $3.39
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.72 / $12.59 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $12.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $446.68 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $12.88 / $263.03
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $208.93
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $229.09 / $245.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.88 / $9.12 / $11.75
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.88 / $9.12 / $11.75
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.71 / $125.89 / $134.90