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Alaska rates for HCPCS Q4104

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

Facilitymedian $74 · 10th–90th $32–$1660%10%20%10th90th$74Professionalmedian $52 · 10th–90th $51–$3020%20%40%10th90th$52$20.0$50.0$100.0$200.0$500.0$1.0K$2.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $56.23 / $134.90
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $112.20 / $177.83
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $89.13 / $97.72
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $61.66 / $144.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $66.07 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $107.15 / $316.23