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South Carolina rates for HCPCS L5975

All Lower Extremity Prosthesis Combination Single Axis Ankle And Flexible Keel Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.74 / $251.74 / $251.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.70 / $251.74 / $418.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.00 / $436.90 / $624.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.31 / $362.03 / $399.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $338.38 / $362.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.41 / $404.00 / $883.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $340.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.25 / $380.25 / $380.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.03 / $274.51 / $375.80