go back

North Dakota rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $35.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.26 / $30.67 / $33.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.80 / $48.80 / $56.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.94 / $31.25 / $38.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $31.23 / $54.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $30.30 / $33.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $32.83