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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
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $14.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $23.99 / $23.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $102.33 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $36.31 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $13.80 / $15.49
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $38.02 / $46.77
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $16.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $11.75 / $21.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $16.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $39.81 / $138.04