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Minnesota rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,084.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $871.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.74 / $827.80 / $871.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.16 / $843.78 / $1,186.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.91 / $358.86 / $388.43
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.80 / $773.27 / $1,068.76
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.85 / $305.85 / $326.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $871.37 / $1,920.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.37 / $871.37 / $1,579.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,908.68