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North Carolina rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.20 / $12.71 / $12.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.71 / $12.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.74 / $6.31 / $22.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.02 / $11.70 / $16.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.21 / $11.88 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $13.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.34 / $12.71 / $17.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $4.38 / $15.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $15.70 / $22.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $15.44
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.16 / $1,591.16 / $1,591.16