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North Dakota rates for HCPCS Q4157

Revitalon, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.65 / $167.65 / $167.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $173.93 / $209.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.07 / $166.55 / $180.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.65 / $167.65 / $285.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $227.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $220.36