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Minnesota rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $372 · 10th–90th $120–$1,5850%20%10th90th$372Professionalmedian $316 · 10th–90th $100–$3720%50%10th90th$316$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $120.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $1,584.89 / $5,623.41
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $316.23 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $162.18 / $186.21
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $380.19 / $549.54
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $158.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $120.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $125.89 / $245.47