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South Carolina rates for HCPCS L5694

Addition To Lower Extremity Above Knee Pelvic Control Belt Padded And Lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.41 / $97.41 / $97.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.75 / $97.41 / $162.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.00 / $163.89 / $231.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.98 / $140.85 / $155.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $137.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.89 / $156.00 / $341.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.00 / $122.00 / $132.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.13 / $147.13 / $147.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.14 / $108.63 / $163.66