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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.16 / $47.63 / $10,291.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.63 / $47.63 / $53.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.76 / $53.76 / $98.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.12 / $51.00 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $80.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.87 / $47.63 / $89.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.93 / $14.93 / $63.67
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.10 / $36.29 / $75.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $51.00 / $67.31
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $231.33
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.33 / $231.33 / $231.33