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South Carolina rates for HCPCS L3209

Surgical Boot Each Child (Special Coverage Instructions Apply. See Mcm: 2079)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.80 / $12.80 / $12.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.80 / $12.80 / $25.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.50 / $18.54 / $25.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.60 / $27.60 / $32.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.14 / $22.93 / $27.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.80 / $15.87 / $39.47
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.01 / $31.01 / $31.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.48 / $16.11 / $25.59