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North Carolina rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.00 / $85.00 / $85.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $49.76 / $60.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $95.00 / $110.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $95.00 / $95.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $212.41
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $150.00 / $200.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.00 / $380.00 / $450.00