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Texas rates for HCPCS Q4104

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

Facilitymedian $81 · 10th–90th $40$4170%20%10th90th$81Professionalmedian $51 · 10th–90th $51$1260%50%90th$51$2.0$10.0$50.0$200.0$1.0K$5.0K

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 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $56.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $97.72 / $181.97
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $177.83 / $6,918.31
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $302.00 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $51.29 / $138.04
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $53.70 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $51.29 / $52.48
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $34.67 / $38.02
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $51.29 / $147.91
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $81.28 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89