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Restorigin

South Carolina rates for HCPCS Q4191

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

Rates data updated July 2026.

Facilitymedian $692 · 10th–90th $182$1,3180%20%40%10th90th$692Professionalmedian $661 · 10th–90th $126$7240%50%10th90th$661$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$912.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$660.69
Typical High
$707.95
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,548.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$1,548.82
Typical High
$1,949.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$691.83
Typical High
$1,737.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$125.89