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Minnesota rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $674.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1,524.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.34 / $730.43 / $1,537.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,931.85 / $3,550.06 / $4,989.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.48 / $1,197.38 / $1,456.01
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,715.75 / $3,253.41 / $4,496.64
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.90 / $957.90 / $1,302.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.43 / $730.43 / $1,609.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.43 / $730.43 / $1,675.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,292.74