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South Carolina rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.97 / $511.97 / $511.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $489.60 / $511.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $926.55 / $1,125.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.99 / $487.59 / $487.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.63 / $756.99 / $1,083.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.00 / $931.00 / $931.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.58 / $487.59 / $536.35