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North Dakota rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $76.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.34 / $76.89 / $83.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.28 / $231.28 / $265.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.86 / $75.79 / $91.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $113.69 / $153.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.50 / $83.18 / $93.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $84.88