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North Carolina rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.00 / $459.00 / $459.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.00 / $459.00 / $3,876.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,982.92 / $2,136.15 / $2,278.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,483.15 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,420.00 / $3,692.14 / $3,692.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.00 / $513.00 / $3,762.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.00 / $513.00 / $513.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,309.10 / $5,309.10 / $5,309.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,171.60 / $2,929.02 / $3,692.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $4,873.62
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,144.85 / $4,911.24 / $8,289.69
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,970.00 / $11,970.00 / $14,244.40