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North Dakota rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $177.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $128.82 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $177.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $190.55 / $251.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $151.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $165.96 / $239.88