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Colorado 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 / $51.29 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $61.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $47.86 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $52.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $190.55 / $213.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $134.90 / $134.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $125.89