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South Carolina rates for HCPCS L6715

Terminal Device Multiple Articulating Digit Includes Motor(S) Initial Issue Or Replacement (Reinstated Code Previous Description Was Terminal Device Hook Dorrance Or Equal Model # 5xa (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,714.26 / $1,714.26 / $1,714.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,618.85 / $1,714.26 / $2,852.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.00 / $302.58 / $3,985.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.26 / $2,381.07 / $2,628.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,738.18 / $1,738.18 / $2,381.07
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.00 / $2,426.39 / $6,018.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $231.00 / $249.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,415.86 / $1,911.75 / $2,618.15