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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
$75.86 / $75.86 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $95.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $128.82 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $107.15 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $288.40 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $97.72 / $112.20
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $295.12 / $371.54
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $173.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $177.83 / $302.00