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North Carolina rates for HCPCS A2007

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.44 / $205.70 / $205.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.92 / $55.94 / $61.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.97 / $205.70 / $266.20
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.10 / $177.10 / $177.10
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.70 / $101.70 / $101.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.26 / $98.26 / $132.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.00 / $220.00 / $286.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.90 / $363.00 / $484.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.60 / $919.60 / $1,089.00