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New York rates for HCPCS Q4104

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

Facilitymedian $59 · 10th–90th $51$2000%20%40%10th90th$59Professionalmedian $52 · 10th–90th $49$1200%50%10th90th$52$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 / $120.23 / $19,054.61
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $67.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $63.10
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $138.04 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $144.54 / $338.84
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $199.53
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $52.48
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $52.48 / $52.48
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $58.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $52.48 / $125.89
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $56.23
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $52.48 / $52.48