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North Dakota rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $794.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $616.60 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,047.13 / $1,318.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,174.90 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,096.48 / $1,230.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $269.15 / $1,659.59