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South Carolina rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.20 / $230.20 / $230.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.20 / $230.20 / $407.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.00 / $340.40 / $493.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.15 / $290.63 / $320.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $279.69 / $290.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.97 / $334.00 / $730.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.00 / $262.00 / $281.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.28 / $314.28 / $314.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $229.97 / $294.41