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South Carolina rates for HCPCS L5698

Addition To Lower Extremity Above Knee Or Knee Disarticulation Silesian Bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.48 / $70.48 / $70.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.26 / $70.48 / $117.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $119.78 / $168.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.17 / $99.25 / $109.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $94.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.51 / $113.00 / $247.43
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $89.00 / $95.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.46 / $106.46 / $106.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $94.11 / $98.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.05 / $77.90 / $94.75