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North Carolina rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.36 / $181.36 / $181.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.36 / $181.36 / $688.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.50 / $565.03 / $602.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.98 / $656.12 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $928.48
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.47 / $181.36 / $1,834.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.47 / $144.47 / $323.83
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,533.10 / $1,533.10 / $1,533.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $852.96
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.80 / $1,457.75 / $2,915.49
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,838.00 / $5,838.00 / $5,838.00