go back

Minnesota rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $32.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $36.28 / $76.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.24 / $30.30 / $30.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.78 / $85.97 / $120.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.25 / $36.22 / $39.29
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.55 / $78.79 / $108.89
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.94 / $30.94 / $33.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $30.30 / $67.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $30.30 / $69.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $63.48