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North Dakota rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,230.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $977.24 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $380.19 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,000.00 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $870.96 / $954.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $269.15 / $1,000.00