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South Carolina rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $776.25 / $776.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $165.96 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $616.60 / $2,238.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $54.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,454.71 / $2,818.38