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South Carolina rates for HCPCS L7404

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.77 / $301.77 / $301.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.00 / $301.77 / $502.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.12 / $607.12 / $607.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.00 / $535.35 / $764.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $479.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $405.68 / $434.07
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.33 / $492.16 / $1,059.43
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.64 / $493.64 / $493.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.36 / $333.55 / $460.81