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South Carolina rates for HCPCS Q4253

Zenith Amniotic Membrane Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.58 / $79.58 / $79.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $79.58 / $614.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $985.53 / $1,315.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.58 / $368.20 / $1,140.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.00 / $798.00 / $798.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $79.57 / $92.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.20 / $75.79 / $83.37