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Kentucky 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–$910%50%90th$51Professionalmedian $51 · 10th–90th $51–$690%50%90th$51$10.0$20.0$50.0$100.0$200.0$500.0

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 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $56.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $61.66
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $81.28
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $54.95 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $125.89 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $70.79
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $125.89 / $125.89