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Minnesota rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $13.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $12.30 / $22.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.58 / $13.76 / $14.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.77 / $38.18 / $53.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.73 / $15.75 / $16.23
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.45 / $34.97 / $48.35
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.60 / $12.60 / $14.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.10 / $14.48 / $32.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.48 / $14.48 / $28.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $25.37