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South Carolina rates for HCPCS L5647

Addition To Lower Extremity Below Knee Suction Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.11 / $427.11 / $427.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.11 / $427.11 / $710.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.33 / $668.33 / $859.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.00 / $699.71 / $1,012.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.22 / $596.58 / $658.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $604.34
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.86 / $684.00 / $1,499.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.00 / $537.00 / $577.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.15 / $645.15 / $645.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.65 / $717.65 / $733.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.72 / $476.31 / $717.65