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Minnesota rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,019.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2,448.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.80 / $1,902.17 / $1,961.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,080.59 / $5,661.06 / $7,957.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,072.52 / $2,385.79 / $2,606.04
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,736.00 / $5,188.00 / $7,170.51
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,052.00 / $2,052.00 / $2,188.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $4,321.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $4,498.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $3,554.90