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South Carolina rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.13 / $75.13 / $75.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.25 / $71.55 / $75.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.94 / $119.92 / $199.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $94.80 / $120.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $71.55 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.04 / $49.84 / $104.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.04 / $14.04 / $14.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.83 / $71.55 / $78.70