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Virginia rates for HCPCS Q4104

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

Facilitymedian $54 · 10th–90th $51$2820%50%10th90th$54Professionalmedian $52 · 10th–90th $51$1260%50%10th90th$52$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 / $52.48 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $81.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $114.82
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $83.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $131.83 / $239.88
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $53.70 / $93.33
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $64.57 / $79.43
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $64.57 / $79.43
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $125.89