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North Carolina rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.46 / $164.46 / $164.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $164.46 / $164.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.85 / $59.09 / $63.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.78 / $76.09 / $76.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $170.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.18 / $170.26 / $369.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.28 / $170.26 / $170.26
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.50 / $111.50 / $111.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.35 / $105.35 / $142.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $98.92
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.18 / $285.18 / $375.43
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.97 / $404.97 / $408.74