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South Carolina rates for HCPCS Q4219

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $117.49 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $1,047.13 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $85.11 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $724.44 / $794.33