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South Carolina rates for HCPCS L3003

Foot insert, removable, molded to patient model, silicone gel, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.47 / $104.47 / $104.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.23 / $104.47 / $184.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $138.66 / $223.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.40 / $149.11 / $164.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.85 / $126.93 / $149.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.92 / $146.26 / $331.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.00 / $122.00 / $122.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.20 / $100.60 / $140.94