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Iowa 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$810%50%90th$51Professionalmedian $52 · 10th–90th $51$850%50%10th90th$52$0.1$0.5$2.0$10.0$50.0$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
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $81.28 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $52.48 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $223.87 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $63.10 / $95.50
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $51.29 / $93.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $61.66 / $91.20
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $53.70 / $100.00
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $61.66 / $67.61
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $208.93 / $269.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $83.18 / $95.50
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $34.67 / $38.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.05 / $50.12 / $81.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $131.83
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29