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South Carolina rates for HCPCS L2628

Addition To Lower Extremity Pelvic Control Metal Frame Reciprocating Hip Joint And Cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,125.02 / $1,125.02 / $1,125.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.79 / $1,125.02 / $1,990.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.00 / $1,657.87 / $2,409.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,012.30 / $1,179.41 / $1,302.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $1,179.40 / $1,366.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$990.07 / $1,629.00 / $3,406.34
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.00 / $1,278.00 / $1,373.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,535.95 / $1,535.95 / $1,535.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.99 / $1,045.41 / $1,366.55