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South Carolina rates for HCPCS L5655

Addition To Lower Extremity Socket Insert Below Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.90 / $150.90 / $150.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.90 / $150.90 / $251.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.00 / $246.14 / $357.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.22 / $221.07 / $244.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $202.85 / $221.07
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.11 / $242.00 / $529.77
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.00 / $190.00 / $204.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.94 / $227.94 / $227.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.36 / $168.29 / $239.30