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South Carolina rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,023.29 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $912.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $165.96 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $812.83 / $2,238.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $933.25 / $1,862.09