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North Dakota rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $104.71 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $181.97 / $223.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $169.82 / $389.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $239.88 / $812.83