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South Carolina rates for HCPCS L8020

Breast Prosthesis Mastectomy Form (Special Coverage Instructions Apply. See Mcm: 2130 A)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.42 / $122.42 / $122.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.55 / $122.42 / $203.67
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.71 / $184.71 / $184.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $196.91 / $296.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.87 / $170.64 / $188.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.00 / $124.57 / $170.64
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.76 / $197.00 / $429.39
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.00 / $154.00 / $174.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.90 / $184.90 / $184.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.92 / $133.49 / $204.92