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South Carolina rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,621.81 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,884.03 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,737.80 / $5,011.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $3,801.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,737.80 / $1,905.46
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,187.76 / $4,677.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $912.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,089.30 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,445.44 / $2,089.30