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North Dakota rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $63.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.28 / $63.31 / $68.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.66 / $139.66 / $160.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.50 / $65.15 / $80.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $92.63 / $112.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.81 / $59.81 / $66.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $69.90