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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
$1,052.89 / $1,052.89 / $1,052.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,063.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.49 / $1,068.03 / $1,156.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.00 / $479.00 / $550.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.85 / $382.31 / $1,052.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $1,089.26 / $1,895.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.18 / $871.37 / $975.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,143.49