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Hawaii rates for HCPCS Q4104

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

Professionalmedian $51 · 10th–90th $51–$790%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
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $66.07 / $125.89
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $79.43 / $91.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $173.78 / $218.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $125.89 / $125.89