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Virginia rates for HCPCS Q4124

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

Facilitymedian $3 · 10th–90th $2–$1260%20%10th90th$3Professionalmedian $2 · 10th–90th $2–$350%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. 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 / $15.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $22.39
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.89 / $12.59 / $12.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $131.83 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $2.82 / $15.49
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.34 / $2.95 / $14.13
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.34 / $2.95 / $14.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $19.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $125.89 / $125.89