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Minnesota rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $72.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $108.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.83 / $71.04 / $122.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.97 / $268.26 / $377.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.67 / $93.66 / $113.05
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.65 / $245.84 / $339.79
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.93 / $74.93 / $101.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.04 / $71.04 / $156.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $71.04 / $162.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $128.16