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North Carolina rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.79 / $277.79 / $277.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.79 / $277.79 / $1,105.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.52 / $208.47 / $222.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.29 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.00 / $1,052.89 / $1,052.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.39 / $277.79 / $1,097.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.39 / $222.39 / $222.39
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,225.59 / $1,225.59 / $1,225.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,210.82
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,102.55 / $1,400.54 / $1,688.59
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,642.15 / $2,642.15 / $3,476.52