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North Carolina rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.21 / $2,596.81 / $8,358.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.43 / $31.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.88 / $39.47 / $77.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $30.90 / $65.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $54.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.43 / $32.77 / $59.85
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.72 / $32.72 / $38.82
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.80 / $68.50 / $87.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $39.29
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $134.55
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,212.73 / $2,212.73 / $2,212.73