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South Carolina rates for HCPCS L5984

All Endoskeletal Lower Extremity Prostheses Axial Rotation Unit With Or Without Adjustability (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.88 / $305.88 / $305.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.55 / $305.88 / $508.90
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.62 / $478.62 / $478.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $504.29 / $724.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.52 / $427.25 / $471.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.89 / $411.17 / $427.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.26 / $490.00 / $1,073.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $384.00 / $413.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.02 / $462.02 / $462.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.41 / $341.11 / $513.95