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Minnesota rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $79.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $127.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.38 / $79.23 / $104.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.27 / $270.64 / $380.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.85 / $109.97 / $115.10
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.80 / $248.02 / $342.80
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $104.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.23 / $79.23 / $174.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.23 / $79.23 / $181.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $137.94