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North Dakota rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $80.90 / $101.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $83.94 / $101.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.45 / $80.37 / $87.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.88 / $143.88 / $165.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $92.79 / $114.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $101.13 / $136.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $152.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $148.21