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North Carolina rates for HCPCS Q4197

PuraPly XT, 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
$70.79 / $70.79 / $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
$53.70 / $89.13 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $100.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $177.83 / $331.13
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
$74.13 / $120.23 / $134.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $125.89 / $251.19
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $407.38