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South Carolina rates for HCPCS A4402

Lubricant Per Ounce (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $1.78 / $1.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.66 / $1.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.23 / $2.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.34 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.13 / $1.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.17 / $2.00 / $3.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.50 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.01 / $1.34