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North Dakota rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $126 · 10th–90th $126–$1290%50%90th$126Professionalmedian $126 · 10th–90th $81–$1410%50%10th90th$126$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $125.89 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $181.97
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $100.00 / $138.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $239.88