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South Carolina rates for HCPCS L7405

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $436.52 / $660.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $954.99 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $1,023.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $575.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $645.65 / $1,412.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $257.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $588.84 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $436.52 / $602.56