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Minnesota rates for HCPCS Q4102

Oasis 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
$11.88 / $11.88 / $11.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $14.12 / $24.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.36 / $11.70 / $13.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.75 / $34.45 / $48.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.35 / $14.52 / $15.53
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.64 / $31.57 / $43.64
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.23 / $12.23 / $13.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.06 / $11.70 / $25.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $11.70 / $26.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $21.54