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North Carolina rates for HCPCS Q4151

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.88 / $132.88 / $132.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.88 / $132.88 / $141.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.70 / $323.52 / $457.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.38 / $99.52 / $106.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.25 / $134.88 / $134.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.88 / $158.28 / $225.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.28 / $158.28 / $177.79
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.90 / $192.90 / $287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $175.36
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.42 / $199.01 / $633.20
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.20 / $633.20 / $633.20