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California rates for HCPCS Q4104

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

Facilitymedian $87 · 10th–90th $69$2190%50%10th90th$87Professionalmedian $52 · 10th–90th $27$1950%20%40%10th90th$52$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
$51.29 / $52.48 / $26,302.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $194.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $87.10 / $218.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $69.18 / $112.20
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $33.88 / $114.82
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.91 / $12.59 / $27.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $177.83 / $239.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $165.96 / $269.15
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
$660.69 / $660.69 / $660.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $13.18 / $52.48
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $51.29 / $194.98
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $125.89 / $125.89
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $17.78 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $125.89 / $158.49