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South Carolina rates for HCPCS C2622

Prosthesis, penile, noninflatable

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,981.07 / $6,165.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20