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Minnesota rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $7.60 / $15.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.70 / $7.12 / $7.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.09 / $20.38 / $28.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.54 / $8.59 / $9.48
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.85 / $18.68 / $25.81
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.46 / $7.46 / $7.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.12 / $15.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.12 / $16.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $14.27