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South Carolina rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.61 / $227.61 / $227.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.61 / $227.61 / $402.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.00 / $340.40 / $487.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.82 / $352.55 / $389.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $276.54 / $352.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.64 / $330.00 / $722.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.00 / $259.00 / $278.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.36 / $227.38 / $309.27