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North Carolina rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.28 / $19.28 / $19.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.28 / $19.28 / $24.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.63 / $30.12 / $34.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.63 / $19.28 / $31.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.63 / $14.63 / $14.63
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.30 / $24.30 / $24.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $37.29
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $85.00 / $85.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.02 / $109.02 / $129.11