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North Dakota rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.34 / $2.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $14.45 / $16.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $9.33 / $11.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $3.47 / $16.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $9.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $107.15 / $138.04