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Georgia 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
$33.74 / $51.00 / $7,363.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $56.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $52.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $99.96
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
$52.40 / $52.40 / $91.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.71 / $94.36 / $239.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $51.00 / $78.03