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South Carolina rates for HCPCS Q4133

Grafix Prime Grafixpl Prime Stravix And Stravixpl Per Square Centimeter (Desc Rvsd 1/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.68 / $8,611.01 / $8,611.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.79 / $138.74 / $145.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.90 / $74.84 / $117.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $180.00 / $208.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $138.74 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.56 / $173.68 / $294.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.68 / $167.68 / $167.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.98 / $145.67 / $177.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.64 / $138.74 / $152.61