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Minnesota rates for HCPCS A2015

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $83.18 / $154.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $125.89 / $125.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $109.65 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $602.56 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $173.78 / $186.21
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $169.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $1,230.27 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,230.27 / $1,548.82