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North Carolina rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $6,456.54 / $43,651.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $30.20 / $32.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $89.13 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $33.11 / $85.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $194.98 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $40.74 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $30.20 / $125.89
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90