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North Carolina rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.84 / $102.85 / $52,054.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.22 / $102.85 / $102.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.52 / $33.72 / $36.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.35 / $115.50 / $146.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $109.54 / $133.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.54 / $109.54 / $109.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $145.19
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.95 / $181.50 / $242.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.80 / $459.80 / $544.50