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Minnesota rates for HCPCS Q4157

Revitalon, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.56 / $209.56 / $209.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $173.93 / $209.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $245.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.81 / $158.60 / $163.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.74 / $209.56 / $209.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $465.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $367.82