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South Carolina rates for HCPCS L5699

All Lower Extremity Prostheses Shoulder Harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.98 / $126.98 / $126.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.24 / $126.98 / $211.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.00 / $208.03 / $300.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.41 / $169.96 / $187.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $170.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.03 / $204.00 / $445.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $172.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.04 / $138.46 / $170.69