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Oklahoma rates for HCPCS Q4104

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

Facilitymedian $58 · 10th–90th $52–$1910%20%10th90th$58Professionalmedian $51 · 10th–90th $51–$1260%50%90th$51$20.0$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
$54.95 / $54.95 / $54.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $63.10
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $331.13 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $61.66 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $53.70 / $79.43
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $81.28 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $125.89