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South Carolina rates for HCPCS A2001

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.00 / $1,230.00 / $1,230.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,230.00 / $1,245.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.06 / $1,290.36 / $1,979.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.40 / $1,545.00 / $1,875.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.60 / $1,353.00 / $2,045.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.60 / $957.60 / $957.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.00 / $984.00 / $1,033.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.00 / $1,250.00 / $1,375.00