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South Carolina rates for HCPCS L5704

Custom Shaped Protective Cover Below Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.80 / $287.80 / $287.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.80 / $287.80 / $478.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.41 / $643.35 / $643.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.00 / $472.78 / $681.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.52 / $394.91 / $436.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $386.87 / $394.91
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.29 / $461.00 / $1,010.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.00 / $362.00 / $389.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.73 / $434.73 / $434.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.94 / $318.10 / $475.05