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Nebraska rates for HCPCS Q4104

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

Facilitymedian $54 · 10th–90th $49$2090%20%40%10th90th$54Professionalmedian $51 · 10th–90th $51$850%50%90th$51$20.0$50.0$100.0$200.0$500.0$1.0K

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
$51.29 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $81.28
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $54.95 / $57.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $54.95 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $190.55 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $64.57 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $74.13 / $104.71
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $53.70 / $81.28
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $60.26 / $79.43
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $204.17 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $134.90
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $38.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $81.28 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $120.23 / $125.89