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Wisconsin rates for HCPCS Q4104

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

Facilitymedian $55 · 10th–90th $50–$2000%20%40%10th90th$55Professionalmedian $52 · 10th–90th $51–$1260%50%10th90th$52$5.0$20.0$100.0$500.0$2.0K

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
$52.48 / $52.48 / $52.48
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $56.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $67.61 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $125.89 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $125.89 / $151.36
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $112.20
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $56.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $54.95 / $117.49
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $120.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $52.48 / $54.95
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $54.95 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $229.09 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $85.11 / $229.09
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $58.88 / $229.09
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $380.19
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $79.43 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $134.90