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North Carolina rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.36 / $907.36 / $907.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $907.36 / $907.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.26 / $675.74 / $743.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.44 / $735.05 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,040.16
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.36 / $1,542.51 / $2,442.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,554.00 / $1,554.00 / $1,554.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.70 / $1,143.70 / $1,143.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,051.11
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.00 / $1,887.00 / $4,295.12
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,295.12 / $4,295.12 / $4,295.12