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Minnesota rates for HCPCS Q4104

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $52.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $49.79 / $104.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.01 / $51.07 / $53.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.68 / $140.91 / $198.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.24 / $59.38 / $64.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.09 / $129.13 / $178.48
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $54.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.83 / $53.76 / $96.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.76 / $53.76 / $123.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $92.45