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Minnesota rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $121.00 / $121.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $100.43 / $121.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $371.70 / $3,138.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.36 / $360.55 / $371.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.80 / $121.00 / $121.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $252.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $203.94