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Montana rates for HCPCS Q4104

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

Facilitymedian $56 · 10th–90th $49–$1510%50%10th90th$56Professionalmedian $51 · 10th–90th $51–$1260%50%90th$51$10.0$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $117.49
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64,565.42 / $77,624.71 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $61.66 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $51.29 / $95.50
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $51.29 / $95.50
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $56.23 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $74.13 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89