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North Dakota rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $72.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.53 / $72.58 / $79.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.02 / $60.02 / $69.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.33 / $47.91 / $71.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.84 / $71.55 / $128.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $80.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $80.14