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South Carolina rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $109.65 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $81.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $125.89 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $87.10 / $173.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $83.18 / $125.89