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South Carolina rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $691.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $165.96 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $691.83 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,023.29 / $1,659.59