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Minnesota rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $446.68 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $125.89 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $891.25 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $354.81 / $389.05
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $933.25 / $1,148.15
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $302.00 / $1,000.00