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South Carolina rates for HCPCS L5964

Addition Endoskeletal System Above Knee Flexible Protective Outer Surface Covering System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.85 / $502.85 / $502.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.85 / $502.85 / $836.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.00 / $825.78 / $1,191.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.63 / $702.38 / $775.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.74 / $675.95 / $702.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.20 / $806.00 / $1,765.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.00 / $632.00 / $679.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.55 / $759.55 / $759.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.85 / $560.78 / $844.92