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South Carolina rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $125.89 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $7.94 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $8.71 / $17.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.94 / $125.89