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Minnesota rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $64.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $87.52 / $2,777.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.85 / $59.81 / $78.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.88 / $246.02 / $345.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.15 / $80.63 / $98.04
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.90 / $225.46 / $311.61
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.50 / $64.50 / $87.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $59.81 / $131.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.81 / $59.81 / $137.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $113.14