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Minnesota rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.24 / $53.24 / $53.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $44.19 / $53.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $45.87 / $199.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.46 / $29.66 / $30.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.12 / $53.24 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $101.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $80.42