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New Jersey rates for HCPCS Q4104

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

Facilitymedian $3,090 · 10th–90th $51–$19,9530%10%10th90th$3,090Professionalmedian $51 · 10th–90th $50–$1260%50%10th90th$51$10.0$50.0$200.0$1.0K$5.0K$20.0K

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 / $6,606.93 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $61.66
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $77.62 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $165.96
Horizon BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $8,709.64 / $23,988.33
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $69.18 / $69.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $54.95 / $125.89