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South Carolina rates for HCPCS L7401

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.31 / $186.31 / $186.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.94 / $186.31 / $309.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.83 / $374.83 / $374.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.00 / $326.14 / $465.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $295.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $250.43 / $267.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.32 / $303.82 / $654.08
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.74 / $304.74 / $304.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.90 / $203.16 / $284.45