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Nationwide rates for HCPCS Q4104

Integra bilayer matrix wound dressing (BMWD), per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $58.88 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $69.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $64.57 / $269.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $67.61 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $51.29 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $64.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $81.28 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $85.11 / $125.89