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Florida 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 / $53.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $53.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.12 / $51.00 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.50 / $51.00 / $51.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.48 / $13.42 / $74.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.51
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $53.76 / $53.76