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Michigan rates for HCPCS Q4104

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

Facilitymedian $52 · 10th–90th $52–$1020%20%40%90th$52Professionalmedian $51 · 10th–90th $19–$850%50%10th90th$51$5.0$10.0$20.0$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
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.31 / $12.30 / $12.30
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $19.50 / $20.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $125.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $85.11 / $229.09
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $85.11 / $138.04
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $125.89