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South Carolina rates for HCPCS Q4205

Membrane Graft Or Membrane Wrap Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,299.15 / $1,299.15 / $1,299.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.90 / $1,237.28 / $1,299.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,680.00 / $1,938.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.25 / $1,237.28 / $1,237.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,237.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,237.28 / $1,596.00 / $2,208.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,596.00 / $1,596.00 / $1,596.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,055.97 / $1,274.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.97 / $1,237.28 / $1,361.01