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South Carolina rates for HCPCS L8039

Breast prosthesis, not otherwise specified

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.06 / $47.06 / $47.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.06 / $47.06 / $53.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.47 / $249.47 / $249.47
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.06 / $47.06 / $77.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.00 / $105.00 / $105.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00