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South Carolina rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $158.49 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $208.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $165.96 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $138.04 / $977.24
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 / $177.83 / $812.83