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Virginia rates for HCPCS Q4124

Oasis Tri-Layer Wound Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.61 / $2.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $3.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.48 / $12.48 / $12.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.35 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.49 / $14.57
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.61 / $11.57
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.00 / $15.94 / $22.27
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.98 / $14.25
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.98 / $14.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.66