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North Dakota rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $22.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $23.81 / $28.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.04 / $28.16 / $30.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.02 / $27.02 / $31.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.25 / $21.56 / $24.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $39.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $32.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $32.13