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North Dakota rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $13.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $12.05 / $13.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.55 / $19.55 / $22.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.23 / $12.35 / $15.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $12.50 / $21.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $11.70 / $13.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.90