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North Carolina rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.70 / $596.70 / $596.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.70 / $596.70 / $2,068.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.89 / $526.66 / $561.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,701.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.70 / $666.90 / $2,971.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.90 / $666.90 / $666.90
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,516.69 / $2,516.69 / $2,516.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.40 / $1,969.89 / $2,251.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,363.87
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,620.33 / $4,051.80 / $5,402.40
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,264.56 / $10,264.56 / $12,155.40