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South Carolina rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$984.00 / $984.00 / $984.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $984.00 / $996.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.83 / $87.01 / $105.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.70 / $984.00 / $1,408.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.70 / $112.70 / $112.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $85.12 / $860.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.54 / $788.99 / $844.22