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Minnesota rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $134.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $354.81 / $354.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $125.89 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $707.95 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $199.53 / $229.09
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $724.44 / $912.01
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $194.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $288.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $190.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $263.03 / $812.83