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Minnesota rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $14,874.95 / $52,174.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $26.44 / $29,910.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $43.36 / $68.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.82 / $30.10 / $31.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.85 / $87.94 / $123.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.19 / $37.06 / $40.47
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.50 / $80.59 / $111.38
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.88 / $31.88 / $34.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $56.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $56.40