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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)

Facilitymedian $85 · 10th–90th $52–$2000%20%10th90th$85Professionalmedian $51 · 10th–90th $51–$850%50%90th$51$50.0$100.0$200.0

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
$52.48 / $85.11 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $61.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $69.18 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $144.54 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $69.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $32.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $63.10 / $125.89