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Texas 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 $3$7080%20%10th90th$4Professionalmedian $2 · 10th–90th $2$1260%50%90th$2$2.0$10.0$50.0$200.0$1.0K$5.0K

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 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $3.02
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $302.00 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,370.32 / $5,370.32 / $5,370.32
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $2.63 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.51 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $10.00 / $30.20
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $14.79 / $14.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $2.75 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.55 / $15.14 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89