go back

New Mexico rates for HCPCS Q4104

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

Facilitymedian $126 · 10th–90th $49–$3630%10%10th90th$126Professionalmedian $51 · 10th–90th $51–$1260%50%90th$51$10.0$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $234.42 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $57.54 / $112.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.38 / $51.29 / $147.91
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $125.89