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South Carolina rates for HCPCS L4130

Replace pretibial shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $323.59 / $575.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $660.69 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $371.54 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $676.08
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $338.84 / $380.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $467.74 / $1,047.13
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $181.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $346.74 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $323.59 / $416.87