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Minnesota rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $23.81 / $28.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $36.49 / $2,777.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $23.16 / $24.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.90 / $47.59 / $66.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.42 / $20.23 / $21.91
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.00 / $43.61 / $60.28
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.25 / $17.25 / $18.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $16.91 / $44.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $65.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $56.60