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North Carolina rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.37 / $16.37 / $16.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $16.37 / $16.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.26 / $8.26 / $16.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.80 / $10.56 / $11.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.86 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.85 / $12.86 / $12.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.89 / $13.36 / $20.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.89 / $9.53 / $17.25
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.10 / $14.20 / $20.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $16.98
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $90.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.88 / $66.88 / $66.88