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North Carolina rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $177.83 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $112.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $123.03 / $229.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $89.13 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $173.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $125.89 / $223.87
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $194.98 / $251.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $173.78 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $125.89 / $165.96
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74