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South Carolina rates for HCPCS L6696

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.24 / $714.24 / $714.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.48 / $714.24 / $1,188.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,596.58 / $1,596.58 / $1,921.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$886.63 / $886.63 / $978.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.24 / $886.63 / $960.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.94 / $1,168.29 / $2,507.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,168.29 / $1,168.29 / $1,168.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.85 / $1,078.85 / $1,078.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.91 / $789.41 / $1,066.57