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South Carolina rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.14 / $318.14 / $318.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.25 / $318.14 / $529.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $504.29 / $754.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $623.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $427.67 / $564.36
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.47 / $520.40 / $1,150.73
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.40 / $520.40 / $520.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.56 / $480.56 / $480.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.76 / $351.63 / $502.37