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North Dakota rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.60 / $13.04 / $14.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.67 / $21.67 / $24.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.60 / $12.86 / $15.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $14.48 / $24.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $14.48 / $16.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $20.00