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North Carolina rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.84 / $100.84 / $100.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $100.84 / $1,020.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $49.76 / $60.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.84 / $112.70 / $1,320.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.70 / $112.70 / $112.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.60 / $315.60 / $788.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $1,041.47
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,140.00 / $1,800.00 / $2,400.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,560.00 / $4,560.00 / $5,400.00