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Minnesota rates for HCPCS Q4205

Membrane Graft Or Membrane Wrap Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,274.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1,739.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.35 / $1,154.73 / $1,190.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,004.47 / $3,683.52 / $5,177.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.67 / $1,344.89 / $1,552.38
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,780.25 / $3,375.71 / $4,665.68
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.91 / $1,075.91 / $1,424.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.56 / $106.56 / $2,142.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.44 / $1,190.44 / $2,730.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $2,440.83