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Minnesota rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $85.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $128.82 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $102.33 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $257.04 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $95.50 / $107.15
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $269.15 / $331.13
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $114.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $151.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $125.89 / $177.83