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North Dakota rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $112.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.24 / $112.75 / $122.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$547.19 / $547.19 / $629.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.56 / $342.09 / $423.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.26 / $166.73 / $240.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.26 / $130.26 / $332.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $124.49