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Connecticut 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
$53.04 / $53.04 / $87.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.51 / $55.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $52.93 / $63.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.45 / $51.00 / $55.14