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North Carolina rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $130.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.93 / $85.96 / $85.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.95 / $94.95 / $188.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.43 / $96.07 / $122.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $101.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $91.60 / $137.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.60 / $91.60 / $92.09
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.20 / $173.50 / $238.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $177.41
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $157.69 / $202.26
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.00 / $844.00 / $844.00