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North Dakota rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,718.37 / $15,404.40 / $52,174.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $25.82 / $31.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.92 / $49.92 / $57.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.88 / $32.19 / $39.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.89 / $31.11 / $42.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $34.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $33.79