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South Carolina rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.50 / $13.50 / $13.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $13.50 / $16.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $12.93 / $17.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.86 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.89 / $13.50 / $21.97
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.89 / $6.89 / $6.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.83 / $12.86 / $13.50