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South Carolina rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.79 / $381.79 / $381.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.52 / $381.79 / $635.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.05 / $597.41 / $853.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.00 / $586.24 / $904.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.48 / $501.15 / $553.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $501.15 / $513.22
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.78 / $612.00 / $1,340.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.00 / $477.00 / $477.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.69 / $576.69 / $576.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.85 / $416.33 / $602.86