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North Carolina rates for HCPCS Q4125

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $138.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.91 / $138.91 / $138.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.24 / $134.24 / $256.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $49.76 / $60.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $180.60
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00