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South Carolina rates for HCPCS Q4102

Oasis wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $16.60 / $16.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $13.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $7.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $46.77 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.75 / $11.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $13.18 / $25.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $30.20 / $125.89