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South Carolina rates for HCPCS L3221

Orthopedic Footwear Mens Shoe Depth Inlay Each Covered By Medicare. Statute Reference: 1862a8)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.60 / $41.60 / $41.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.60 / $41.60 / $83.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.75 / $53.75 / $53.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $80.34 / $110.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.84 / $69.84 / $124.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.99 / $69.84 / $69.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.60 / $51.58 / $129.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.50 / $101.50 / $148.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.04 / $51.28 / $80.34