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North Carolina rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.25 / $412.25 / $412.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.25 / $412.25 / $688.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.21 / $705.84 / $776.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $927.31
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.25 / $460.75 / $1,925.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.75 / $460.75 / $460.75
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.20 / $1,027.20 / $1,027.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $865.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.50 / $1,487.50 / $4,487.09
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,487.09 / $4,487.09 / $5,361.66