go back

Washington, DC rates for HCPCS Q4104

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

Facilitymedian $51 · 10th–90th $51–$2630%50%90th$51Professionalmedian $51 · 10th–90th $51–$810%50%90th$51$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $58.88
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $74.13 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $263.03 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $114.82 / $141.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $134.90