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South Carolina rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.64 / $70.64 / $70.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $70.64 / $85.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $140.80 / $174.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.47 / $67.27 / $67.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.28 / $81.23 / $206.91
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.28 / $42.28 / $42.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.02 / $69.32 / $73.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.54 / $67.27 / $74.00