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Minnesota rates for HCPCS Q4107

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

Facilitymedian $129 · 10th–90th $85–$2950%20%10th90th$129Professionalmedian $102 · 10th–90th $72–$1260%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $83.18 / $100.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $128.82 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $107.15 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $269.15 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $107.15 / $117.49
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $269.15 / $346.74
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $131.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $263.03