go back

North Dakota rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,729.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,329.57 / $3,745.25 / $4,055.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.82 / $4,769.82 / $5,485.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,045.60 / $3,692.14 / $3,807.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,774.77 / $4,718.55 / $6,645.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,929.02 / $3,774.77 / $4,227.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $4,009.85