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South Carolina rates for HCPCS Q4104

Integra Bilayer Matrix Wound Dressing (Bmwd) Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.55 / $53.55 / $53.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.63 / $51.00 / $53.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $52.71 / $62.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.12 / $51.00 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.87 / $53.04 / $91.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.22 / $15.22 / $15.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.90 / $51.00 / $56.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.92 / $51.00 / $56.10