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North Dakota rates for HCPCS A6258

Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.38 / $4.38 / $4.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.84 / $4.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $6.65 / $7.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.57 / $10.57 / $12.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.13 / $7.20 / $8.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.38 / $6.02 / $10.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.54 / $6.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $2.50 / $4.80