go back

North Dakota rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $151.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.11 / $102.49 / $110.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.09 / $168.09 / $193.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.44 / $108.51 / $134.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.54 / $123.33 / $181.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.54 / $98.54 / $110.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $109.72