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Minnesota rates for HCPCS A2005

Microlyte Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.08 / $182.08 / $182.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.55 / $182.08 / $237.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.00 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.43 / $17.62 / $24.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.41 / $293.41 / $293.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.08 / $458.23 / $561.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $583.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $461.48