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Minnesota rates for HCPCS Q4133

Grafix Prime Grafixpl Prime Stravix And Stravixpl Per Square Centimeter (Desc Rvsd 1/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $160.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $183.36 / $1,309.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.94 / $135.16 / $136.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.48 / $384.96 / $541.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.33 / $162.24 / $176.45
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.05 / $352.79 / $487.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.94 / $138.94 / $148.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.18 / $136.18 / $300.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.18 / $136.18 / $312.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $251.51