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Minnesota rates for HCPCS Q4254

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $354.81 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $616.60 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $125.89 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,148.15 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $436.52 / $501.19
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,202.26 / $1,479.11
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $416.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $467.74 / $524.81