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North Dakota rates for HCPCS Q4122

Dermacell Dermacell Awm Or Dermacell Awm Porous Per Square Centimeter (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.80 / $96.80 / $121.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $100.43 / $121.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.01 / $107.99 / $116.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.80 / $100.43 / $163.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $123.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $149.56