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North Carolina rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.26 / $7.32 / $10.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.32 / $7.32 / $8.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.78 / $7.60 / $20.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.83 / $49.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $7.87 / $7.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.26 / $7.78 / $11.71
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.10 / $7.78 / $9.18
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.30 / $16.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $10.23
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.39 / $32.39 / $32.39