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North Dakota rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $742.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.86 / $745.62 / $807.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,541.66 / $1,541.66 / $1,772.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$936.14 / $962.21 / $1,190.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$813.21 / $1,102.58 / $1,382.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.21 / $813.21 / $935.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $798.30