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South Carolina rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.44 / $325.44 / $325.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.26 / $325.44 / $575.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.00 / $485.38 / $696.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.85 / $373.57 / $412.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $373.57 / $395.42
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.44 / $472.00 / $1,032.65
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.00 / $370.00 / $397.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.31 / $444.31 / $444.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.02 / $325.33 / $420.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.69 / $307.64 / $395.31