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New Hampshire rates for HCPCS Q4104

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

Facilitymedian $62 · 10th–90th $51–$2510%20%10th90th$62Professionalmedian $51 · 10th–90th $51–$980%50%90th$51$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
$51.29 / $61.66 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $63.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $69.18 / $77.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $251.19 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $95.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $52.48 / $125.89
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $109.65