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North Carolina rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.79 / $614.79 / $614.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $614.79 / $614.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.95 / $82.90 / $91.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $969.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.24 / $798.00 / $1,254.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.10 / $798.00 / $798.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.90 / $116.90 / $116.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $108.38
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.00 / $969.00 / $1,140.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,311.00 / $1,311.00 / $1,311.00