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South Carolina rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $22.91 / $23.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $117.49 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $24.55 / $24.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $24.55 / $24.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $28.18 / $50.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $125.89