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North Carolina rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,000.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,412.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,000.00 / $2,951.21
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $229.09 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $4,570.88 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,691.53 / $2,818.38
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,128.31 / $8,128.31 / $8,128.31
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,471.29 / $10,471.29 / $10,715.19