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South Carolina rates for HCPCS Q4124

Oasis Tri-Layer Wound Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.61 / $10.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.69 / $14.25 / $15.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $14.25 / $17.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.49 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $12.43 / $16.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.49 / $2.74