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South Carolina rates for HCPCS L6628

Upper Extremity Addition Quick Disconnect Hook Adapter Otto Bock Or Equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.22 / $257.22 / $257.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.22 / $257.22 / $427.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.00 / $422.34 / $609.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.08 / $444.49 / $490.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $345.76 / $444.49
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.86 / $412.00 / $805.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.00 / $323.00 / $347.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.53 / $388.53 / $388.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.23 / $284.29 / $432.19