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South Carolina rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.66 / $133.86 / $149.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.00 / $112.80 / $167.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.08 / $136.12 / $234.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.90 / $83.61 / $132.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.49 / $128.13 / $216.99