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South Carolina rates for HCPCS L6697

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
$890.00 / $1,122.06 / $1,692.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,111.22 / $1,226.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $811.19 / $1,005.17
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
$531.01 / $796.51 / $1,066.57