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Kansas 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
$80.95 / $80.95 / $80.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $55.08 / $80.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.69 / $39.69 / $39.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.00 / $28.00 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $69.90 / $81.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.76 / $53.76 / $231.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $51.00 / $57.41