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Minnesota rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $101.13 / $101.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $83.94 / $101.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $106.65 / $190.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.77 / $83.38 / $85.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.93 / $253.46 / $356.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.79 / $106.82 / $116.68
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.50 / $232.28 / $321.05
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.88 / $91.88 / $98.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.59 / $92.59 / $155.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $313.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $247.39