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South Carolina rates for HCPCS L5629

Addition To Lower Extremity Below Knee Acrylic Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.63 / $170.63 / $170.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.62 / $170.63 / $283.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.95 / $267.00 / $381.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.00 / $283.67 / $404.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.89 / $248.05 / $273.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $229.38 / $248.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.74 / $274.00 / $537.98
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.00 / $214.00 / $230.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.75 / $257.75 / $257.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.22 / $190.30 / $286.70