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Washington, DC 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
$51.00 / $51.00 / $51.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.31 / $22.31 / $22.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.12 / $48.12 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $64.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.35 / $43.35 / $107.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $51.00 / $82.66