go back

New Jersey 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
$51.29 / $6,606.93 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $60.26 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $53.70
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $181.97
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $8,709.64 / $23,988.33
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $102.33 / $125.89