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South Carolina rates for HCPCS L4387

Walking Boot Non-Pneumatic With Or Without Joints With Or Without Interface Material Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.06 / $95.06 / $95.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.81 / $106.85 / $168.17
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.63 / $195.00 / $195.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.76 / $159.99 / $228.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.81 / $120.81 / $133.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.19 / $118.47 / $120.81
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.06 / $150.33 / $310.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.33 / $150.33 / $150.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.78 / $129.78 / $129.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.88 / $91.55 / $133.57