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South Carolina rates for HCPCS L5648

Addition To Lower Extremity Above Knee Air Fluid Gel Or Equal Cushion Socket. (Rvsdf 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.50 / $353.50 / $353.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.50 / $353.50 / $588.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.00 / $566.12 / $837.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.94 / $589.44 / $650.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.29 / $475.20 / $589.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.64 / $567.00 / $1,098.61
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.00 / $444.00 / $477.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.96 / $533.96 / $533.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.85 / $394.23 / $593.98