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North Dakota rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,009.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,686.97 / $3,022.42 / $3,272.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $3,627.25 / $5,363.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,863.13 / $2,901.66 / $3,249.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,235.95