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South Carolina rates for HCPCS L1755

Legg Perthes Orthotic, (Patten Bottom Type), Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$919.74 / $919.74 / $919.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.48 / $919.74 / $1,627.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.00 / $1,355.29 / $1,969.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$827.63 / $1,395.53 / $1,540.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.74 / $1,018.74 / $1,365.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$826.92 / $1,332.00 / $2,918.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.00 / $1,045.00 / $1,123.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.69 / $1,255.69 / $1,255.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.04 / $889.85 / $1,165.53