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North Dakota rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,989.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,776.44 / $1,998.23 / $2,163.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $2,363.87 / $3,545.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.55 / $1,789.55 / $2,251.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,206.28