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South Carolina rates for HCPCS L7403

Addition To Upper Extremity Prosthesis Below Elbow/Wrist Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.97 / $199.97 / $199.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.83 / $199.97 / $332.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.00 / $346.70 / $484.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $316.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $281.42
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.68 / $326.08 / $702.01
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.10 / $327.10 / $327.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.05 / $302.05 / $302.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.11 / $221.02 / $298.68