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Indiana rates for HCPCS Q4104

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

Facilitymedian $229 · 10th–90th $51–$5130%10%10th90th$229Professionalmedian $51 · 10th–90th $51–$1070%50%90th$51$20.0$100.0$500.0$2.0K$10.0K

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 / $75.86 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $56.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $263.03 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $89.13
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $61.66 / $91.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $125.89 / $125.89