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North Carolina rates for HCPCS Q4104

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

Facilitymedian $60 · 10th–90th $46–$12,0230%10%20%10th90th$60Professionalmedian $51 · 10th–90th $45–$810%50%10th90th$51$1.0$5.0$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
$46.77 / $10,232.93 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $51.29 / $58.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $67.61
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $70.79 / $77.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $52.48 / $91.20
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $316.23
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $194.98 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $81.28 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $125.89
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69