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North Dakota rates for HCPCS Q4239

Amnio-Maxx or Amnio-Maxx Lite, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,902.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,921.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.79 / $1,930.00 / $2,089.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.91 / $3,932.91 / $4,522.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,394.26 / $2,418.21 / $2,992.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,038.50 / $2,700.00 / $3,445.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,038.50 / $2,038.50 / $2,349.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,066.34