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North Carolina rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,949.84 / $2,041.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $251.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,398.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,949.84 / $2,884.03
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
$1,995.26 / $3,311.31 / $3,715.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,995.26 / $1,995.26
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $7,244.36
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $8,511.38