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North Carolina rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.32 / $86.32 / $86.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $86.32 / $86.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.81 / $92.63 / $118.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $62.41 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $88.32
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.93 / $92.63 / $131.27
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.63 / $92.63 / $111.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.20 / $84.20 / $84.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $82.38
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.50 / $149.88 / $262.88
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.95 / $288.95 / $371.52