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South Carolina rates for HCPCS L5987

All Lower Extremity Prosthesis Shank Foot System With Vertical Loading Pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,906.04 / $3,906.04 / $3,906.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,688.65 / $3,906.04 / $6,498.73
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,112.01 / $6,112.01 / $6,112.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,413.00 / $6,848.85 / $9,784.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,866.90 / $6,042.00 / $6,670.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $5,250.71 / $6,042.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,885.45 / $6,255.00 / $13,712.69
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,910.00 / $4,910.00 / $5,276.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,933.06 / $4,317.17 / $5,831.47