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North Dakota rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $71.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $71.70 / $77.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.29 / $152.29 / $175.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.93 / $75.67 / $93.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.04 / $99.46 / $131.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $71.04 / $79.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $79.18