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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)

Facilitymedian $105 · 10th–90th $50–$1700%20%10th90th$105Professionalmedian $102 · 10th–90th $43–$1260%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$500.0

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
$51.29 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $64.57
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $104.71 / $104.71
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $107.15 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $147.91 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $58.88 / $64.57
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $151.36 / $190.55
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $57.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $53.70 / $91.20
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $125.89 / $239.88