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North Carolina rates for HCPCS Q4157

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $173.78 / $177.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $194.98 / $257.04
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
$204.17 / $331.13 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $204.17 / $204.17
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25