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North Dakota rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $660.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $524.81 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,122.02 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $2,818.38 / $4,897.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $269.15 / $2,691.53