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Minnesota rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $14.56 / $2,777.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.98 / $2.48 / $9.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.02 / $25.76 / $36.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.36 / $10.86 / $11.76
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.45 / $23.61 / $32.63
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.26 / $9.26 / $9.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.48 / $5.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.48 / $9.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $4.91