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North Dakota rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $72.44 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $85.11 / $104.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $109.65 / $147.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $85.11 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $120.23 / $138.04