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Minnesota rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.00 / $81.00 / $81.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.00 / $81.00 / $81.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.00 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.01 / $347.56 / $540.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.00 / $100.00 / $100.00