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North Dakota rates for HCPCS Q4103

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.26 / $12.67 / $13.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.09 / $20.09 / $23.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.79 / $12.92 / $15.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $15.00 / $22.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $12.38 / $13.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.99